Provider Demographics
NPI:1588867444
Name:WELTER, CONNIE L (MS, RD, LMNT, CDE)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:WELTER
Suffix:
Gender:F
Credentials:MS, RD, LMNT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22372 OLD LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:IA
Mailing Address - Zip Code:51526-4106
Mailing Address - Country:US
Mailing Address - Phone:712-545-9323
Mailing Address - Fax:
Practice Address - Street 1:8601 W DODGE RD
Practice Address - Street 2:SUITE # 30
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3457
Practice Address - Country:US
Practice Address - Phone:402-354-8797
Practice Address - Fax:402-354-5651
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE312OtherRD, LMNT LICENSE