Provider Demographics
NPI:1942816871
Name:ENGLE, VANESSA YVONNE (RD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:YVONNE
Last Name:ENGLE
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 1:1095 S STATELINE RD
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-4727
Mailing Address - Country:US
Mailing Address - Phone:480-326-3316
Mailing Address - Fax:
Practice Address - Street 1:30 ROWES WHARF FL 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3345
Practice Address - Country:US
Practice Address - Phone:480-326-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered