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Individual

SANDRA CAROL VANCALCAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
840 SW GAINES ST, PORTLAND, OR 97239-2904
(608) 712-2723
Mailing address
840 SW GAINES RD., PORTLAND, OR 97239-0001
(608) 712-2723

Taxonomy

Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
1299
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
710770
DIETITIAN
WI
01
LDD10164644
OREGON LICENSING BOARD
OR
Enumeration date
01/05/2007
Last updated
09/25/2014
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