Provider Demographics
NPI:1285746149
Name:CONNER, ANDREA (MPH, RD, CDE, CFT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:MPH, RD, CDE, CFT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ALBANIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RD, CDE, CFT
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:SUITE 1500B
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-561-2673
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:SUITE 1500B
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:623-561-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO861117133VN1006X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133N00000XDietary & Nutritional Service ProvidersNutritionist