Provider Demographics
NPI:1669884755
Name:VENDELAND, SUSAN CAROL (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CAROL
Last Name:VENDELAND
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10519 DISTRICT LINE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-9789
Mailing Address - Country:US
Mailing Address - Phone:360-335-3002
Mailing Address - Fax:
Practice Address - Street 1:10519 DISTRICT LINE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-9789
Practice Address - Country:US
Practice Address - Phone:360-335-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60407817133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education