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General NPI Number Information
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NPI Number | 1093422099
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Entity Type | Organization
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Legal Business Name | CONNER YODER NUTRITION LLC
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 9804 ACACIA PSGE
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City | FORT WAYNE
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State | IN
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Zip | 46835-9143
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Country | US
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Telephone | 260-479-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 9804 ACACIA PSGE
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City | FORT WAYNE
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State | IN
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Zip | 46835-9143
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Country | US
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Telephone | 260-479-0080
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MR. CONNER YODER
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Credential | RDN, LD
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Telephone | 260-479-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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