Provider Demographics
NPI:1083866016
Name:MANION, CONNIE SUE (RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:MANION
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:SUE
Other - Last Name:NEUMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN/LD
Mailing Address - Street 1:430 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4610
Mailing Address - Country:US
Mailing Address - Phone:580-421-1518
Mailing Address - Fax:580-272-1618
Practice Address - Street 1:1056 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-9575
Practice Address - Country:US
Practice Address - Phone:580-618-4108
Practice Address - Fax:580-272-1618
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#1624 LICENSE DIET133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered