Provider Demographics
NPI:1669844429
Name:VANDERBILT, JESSICA (DNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VANDERBILT
Suffix:
Gender:F
Credentials:DNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15459 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2474
Mailing Address - Country:US
Mailing Address - Phone:623-455-5799
Mailing Address - Fax:
Practice Address - Street 1:15459 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2474
Practice Address - Country:US
Practice Address - Phone:623-455-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No175F00000XOther Service ProvidersNaturopath
No374J00000XNursing Service Related ProvidersDoula