MEDICARE: MS. ANDREA LYNN VANSCOIK RD, CDCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447212592	OTHER		HOSPITAL

General Provider Information

NPI Number	:	1861532657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LYNN VANSCOIK RD, CDCES

Provider Business Mailing Address
First Line	:	2500 POCOSHOCK PL STE 201
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-287-4598
Fax Number	:	804-674-4145

Provider Business Practice Location Address
First Line	:	2500 POCOSHOCK PL STE 201
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6345
Country	:	US
Telephone Number	:	804-764-7885
Fax Number	:	804-674-4145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	04/20/2021

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