Provider Demographics
NPI:1154100394
Name:WAANDERS, DAISY (RD)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:WAANDERS
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:324 INVERNESS DR S APT 3208
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6168
Mailing Address - Country:US
Mailing Address - Phone:720-436-2536
Mailing Address - Fax:
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:602-341-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86168827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered