Healthcare Provider Details

I. General information

NPI: 1861532657
Provider Name (Legal Business Name): ANDREA LYNN VANSCOIK RD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POCOSHOCK PL STE 201
NORTH CHESTERFIELD VA
23235-6345
US

IV. Provider business mailing address

2500 POCOSHOCK PL STE 201
NORTH CHESTERFIELD VA
23235-6345
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-7885
  • Fax: 804-674-4145
Mailing address:
  • Phone: 804-287-4598
  • Fax: 804-674-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: