Provider Demographics
NPI:1962844951
Name:VLASTUIN, ABBY MICHELLE (RD, LN)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MICHELLE
Last Name:VLASTUIN
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2329
Mailing Address - Country:US
Mailing Address - Phone:605-361-0313
Mailing Address - Fax:
Practice Address - Street 1:4101 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2329
Practice Address - Country:US
Practice Address - Phone:605-361-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered