| Doctor Name: | MRS. DESIREE DE WAAL |
| NPI Number: | 1003900358 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | 074-0000171 |
| Business Practice Address: | 1 S Prospect St Uhc Arnold 2318, Renal Clinic Burlington, VT - 054013456 |
| Business Phone Number: | 8028473203 |
| Business Fax Number: | 8028473607 |
| Mailing Address: | 1 S Prospect St, Uhc Arnold 2318, Renal Clinic BURLINGTON |
| State: | VT |
| Postal Code: | 054013456 |
| Phone Number: | 8028473203 |
| Fax Number: | 8028473607 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133VN1005X |
| License Number: | 074-0000171 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | Nutrition, Renal |
| Taxonomy Definition: | |