Healthcare Provider Details

I. General information

NPI: 1033661525
Provider Name (Legal Business Name): CHRISTINA M CROWDER ANDERSON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA MARIE CROWDER RDN

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 CONCERTO LN
CHEYENNE WY
82007-3697
US

IV. Provider business mailing address

1321 CONCERTO LN
CHEYENNE WY
82007-3697
US

V. Phone/Fax

Practice location:
  • Phone: 918-899-6059
  • Fax: 888-231-6240
Mailing address:
  • Phone: 918-899-6059
  • Fax: 888-231-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number304
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2197
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: