| NPI | 1053713941 |
|---|---|
| Other Name | ST. AGNES DIABETES |
| Entity Type | Organization |
| Authorized Contact | KEITH VANDER KOLK President/CEO 667-234-2101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2016-02-25 |