Individual
VANESSA JEAN PROVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
814 LAPORTE AVE, VALPARAISO, IN 46383-5860
(219) 263-4741
(219) 263-7144
Mailing address
325 N KELLY ST, HOBART, IN 46342-3231
(219) 947-3567
(219) 263-7144
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000568
IN
Other
Enumeration date
07/20/2006
Last updated
07/08/2007
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