Provider Demographics
NPI:1710537477
Name:VANGELDEREN, REBECCA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:VANGELDEREN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 WALKERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ADOLPHUS
Mailing Address - State:KY
Mailing Address - Zip Code:42120-6153
Mailing Address - Country:US
Mailing Address - Phone:270-618-0590
Mailing Address - Fax:
Practice Address - Street 1:2065 WALKERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:ADOLPHUS
Practice Address - State:KY
Practice Address - Zip Code:42120-6153
Practice Address - Country:US
Practice Address - Phone:270-618-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1164416163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant