Healthcare Provider Details

I. General information

NPI: 1972682276
Provider Name (Legal Business Name): CONNIE SUE CONNER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

1401 S 950 W
ANDERSON IN
46012-9324
US

V. Phone/Fax

Practice location:
  • Phone: 765-741-1802
  • Fax: 765-741-2994
Mailing address:
  • Phone: 765-759-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: