Provider Demographics
NPI:1124807813
Name:VANDITTO, BELINDA
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:VANDITTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 E SHADOW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5111
Mailing Address - Country:US
Mailing Address - Phone:208-819-6450
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 320
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4485
Practice Address - Country:US
Practice Address - Phone:208-819-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID77632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily