Provider Demographics
NPI:1336703024
Name:HEATWOLE, VANESSA (RDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:HEATWOLE
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 QUINCE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:826 QUINCE DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-4639
Practice Address - Country:US
Practice Address - Phone:540-416-1159
Practice Address - Fax:540-431-2875
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1018497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered