Provider Demographics
NPI:1972390292
Name:VANDENBERGHE, ALISON JEAN (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JEAN
Last Name:VANDENBERGHE
Suffix:
Gender:
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 EMMY LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55341-3100
Mailing Address - Country:US
Mailing Address - Phone:612-219-5405
Mailing Address - Fax:
Practice Address - Street 1:1ST SPECIAL OPERATIONS MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-641-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86117786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered