Provider Demographics
NPI:1013289081
Name:VAN DER HEIJDEN, HOPE (RD)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:VAN DER HEIJDEN
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 1:1915 S AUSTIN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7843
Mailing Address - Country:US
Mailing Address - Phone:512-948-7534
Mailing Address - Fax:
Practice Address - Street 1:1915 S AUSTIN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7843
Practice Address - Country:US
Practice Address - Phone:512-948-7534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82122133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered