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General NPI Number Information
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NPI Number | 1285746149
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Entity Type | Individual
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Provider Name | ANDREA CONNER MPH, RD, CDE, CFT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 6320 W UNION HILLS DR SUITE 1500B
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City | GLENDALE
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State | AZ
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Zip | 85308-1096
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Country | US
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Telephone | 623-561-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 6320 W UNION HILLS DR SUITE 1500B
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City | GLENDALE
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State | AZ
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Zip | 85308-1096
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Country | US
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Telephone | 623-561-2673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 861117
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 861117
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License Number State | MO
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