Individual
MS. MARTI BORDENLON VANDAGRIFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN LDN CDCES
Contact information
Practice address
707 S VIENNA ST, RUSTON, LA 71270
(318) 224-3044
Mailing address
626 WHITEFIELD LANE, BOSSIER CITY, LA 71112
(318) 780-0530
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1254
LA
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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