Provider Demographics
NPI:1740027762
Name:VAN DER MERWE, ALEXANDRA ANN (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ANN
Last Name:VAN DER MERWE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2986
Mailing Address - Country:US
Mailing Address - Phone:630-945-5397
Mailing Address - Fax:
Practice Address - Street 1:2885 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2986
Practice Address - Country:US
Practice Address - Phone:630-945-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87716133V00000X
KS3107133V00000X
86212389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered