Provider Demographics
NPI:1033661525
Name:CROWDER ANDERSON, CHRISTINA M (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:CROWDER ANDERSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1321 CONCERTO LN
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3697
Mailing Address - Country:US
Mailing Address - Phone:918-899-6059
Mailing Address - Fax:888-231-6240
Practice Address - Street 1:1321 CONCERTO LN
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3697
Practice Address - Country:US
Practice Address - Phone:918-899-6059
Practice Address - Fax:888-231-6240
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY304133V00000X
OK2197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered