Provider Demographics
NPI:1356896799
Name:VANDENBARK, ANGELA GUEST (RDN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GUEST
Last Name:VANDENBARK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-9518
Mailing Address - Country:US
Mailing Address - Phone:405-258-8081
Mailing Address - Fax:
Practice Address - Street 1:2013 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-9518
Practice Address - Country:US
Practice Address - Phone:405-258-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1153133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic