Provider Demographics
NPI:1790832152
Name:VANCALCAR, SANDRA CAROL (RD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CAROL
Last Name:VANCALCAR
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 1:840 SW GAINES RD.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-0001
Mailing Address - Country:US
Mailing Address - Phone:608-712-2723
Mailing Address - Fax:
Practice Address - Street 1:840 SW GAINES ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2904
Practice Address - Country:US
Practice Address - Phone:608-712-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1299133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI710770OtherDIETITIAN
ORLDD10164644OtherOREGON LICENSING BOARD