Provider Demographics
NPI:1033100110
Name:SALMON, CINDY JANE (RD)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:JANE
Last Name:SALMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 CROSSMAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1413
Mailing Address - Country:US
Mailing Address - Phone:907-457-6688
Mailing Address - Fax:907-782-4232
Practice Address - Street 1:828 CROSSMAN RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1413
Practice Address - Country:US
Practice Address - Phone:907-457-6688
Practice Address - Fax:907-782-4232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0030133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDT3008Medicaid
AKP46792Medicare UPIN
AKDT3008Medicaid