Provider Demographics
NPI:1649590019
Name:ROGERS, VANDADEAN (LD, LHNA)
Entity type:Individual
Prefix:MS
First Name:VANDADEAN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LD, LHNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S SAINT CLAIR ST
Mailing Address - Street 2:#209
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2127
Mailing Address - Country:US
Mailing Address - Phone:937-443-0367
Mailing Address - Fax:
Practice Address - Street 1:35 S SAINT CLAIR ST
Practice Address - Street 2:#209
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2127
Practice Address - Country:US
Practice Address - Phone:937-443-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL2210133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education