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NPI Code Detail

MEDICARE: MRS. JOAN C CONNOR MS,RD,LDN

MEDICARE:  MRS. JOAN C CONNOR  MS,RD,LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianLDN0000001172TN

General Provider Information

NPI Number : 1073633236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JOAN C CONNOR MS,RD,LDN
Provider Business Mailing Address
First Line : 9933 S HOUSTON WAY
Second Line :
City : GERMANTOWN
State : TN
Zip : 38139-6942
Country : US
Telephone Number : 901-853-6705
Fax Number : 901-853-0463
Provider Business Practice Location Address
First Line : 9933 S HOUSTON WAY
Second Line :
City : GERMANTOWN
State : TN
Zip : 38139-6942
Country : US
Telephone Number : 901-853-6705
Fax Number : 901-853-0463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 07/08/2007

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