Provider Demographics
NPI:1902947468
Name:SVOBODA, ANDREA J (MS RD LMNT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:MS RD LMNT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:URBANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2303
Mailing Address - Country:US
Mailing Address - Phone:402-721-1610
Mailing Address - Fax:402-727-3433
Practice Address - Street 1:450 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2303
Practice Address - Country:US
Practice Address - Phone:402-721-1610
Practice Address - Fax:402-727-3433
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered