Individual
VLADISLAVA IVANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9040 JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-4504
(770) 841-4551
Mailing address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
10/26/2016
Last updated
02/12/2019
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