| Name | Value |
|---|---|
| PROVIDER TYPE | Dietary and Nutritional Service |
| CLASSIFICATION | Dietary Manager |
| AREA OF SPECIALIZATION | Dietary Management |
| STATUS | Inactive |
| DATE INACTIVATED | 2018-04-02 00:00:00 |
| VA CODE | V040100 |
| X12 CODE | 1327D0700N |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252564 |
| EFFECTIVE DATE/TIME |
|