Healthcare Provider Details

I. General information

NPI: 1629300611
Provider Name (Legal Business Name): RANDEE P VANNESS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 FLINTRIDGE DR STE 201
COLORADO SPRINGS CO
80918-4273
US

IV. Provider business mailing address

4740 FLINTRIDGE DR STE 201
COLORADO SPRINGS CO
80918-4273
US

V. Phone/Fax

Practice location:
  • Phone: 719-510-6313
  • Fax: 719-358-7756
Mailing address:
  • Phone: 719-510-6313
  • Fax: 719-358-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: