Active NPI
Lysandra Vander Hart, R.D.
- Registered Dietitian
- Grand Rapids, MI
National Provider Identifier
1659386514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 945076
- Practice address
- 311 State Street
Grand Rapids, MI 49503 - Phone
- (616) 249-0159
- Fax
- (616) 249-8688
- NPI assigned
- Jul 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 945076 | Primary |
Addresses
Primary practice location
311 State Street
Grand Rapids, MI 49503
Mailing address
6941 Cimarron Dr SE
Grand Rapids, MI 49546
Phone (616) 262-0617
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422921600000",
"number": "1659386514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6941 CIMARRON DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"telephone_number": "616-262-0617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 STATE STREET",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49503",
"telephone_number": "616-249-0159",
"fax_number": "616-249-8688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDER HART",
"first_name": "LYSANDRA",
"name_prefix": "Mrs.",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-29",
"last_updated": "2015-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "945076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
- Eric K Vandepol, MD
- Alainna Michelle Vander Ark, NNP
- Mitchell Scott Vander Baan, D.D.S.
- Jennifer Lynn Vander Bos
- Susan Kim Vander Griend
- Donna Kay Vander Kodde, MA, LPC
- Jacob Scott Vander Kolk, LLPC
- John Vander Kolk, D.D.S.
- Karen S Vander Laan, MD
- Vander Linde Family and Cosmetic Dentistry (Renew Family Dental)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.