Provider Demographics
NPI:1316104896
Name:SANDVIG, DEBRA SUE (RD,CD, IBCLC)
Entity type:Individual
Prefix:MR
First Name:DEBRA
Middle Name:SUE
Last Name:SANDVIG
Suffix:
Gender:F
Credentials:RD,CD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N NANUM ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-2886
Mailing Address - Country:US
Mailing Address - Phone:509-962-7515
Mailing Address - Fax:509-962-7581
Practice Address - Street 1:507 N NANUM ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-2886
Practice Address - Country:US
Practice Address - Phone:509-962-7515
Practice Address - Fax:509-962-7581
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA818154133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered