Individual
ANDREA LYNN BODE VANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS RD LD
Contact information
Practice address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-5220
(903) 614-5322
Mailing address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-5220
(903) 614-5322
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
998
AR
133V00000X
Registered Dietitian
Primary
DT80323
TX
Other
Enumeration date
01/13/2010
Last updated
01/13/2010
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