Provider Demographics
NPI:1710054838
Name:VAN-LOON, GLEE (RD)
Entity Type:Individual
Prefix:MS
First Name:GLEE
Middle Name:
Last Name:VAN-LOON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10523 FAIR OAKS BLVD
Mailing Address - Street 2:APT #205
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7500
Mailing Address - Country:US
Mailing Address - Phone:916-965-6714
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00922311133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered