Provider Demographics
NPI:1164880746
Name:DAWSON, KANDI DENISE (RD, CD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KANDI
Middle Name:DENISE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:RD, CD, CDE
Other - Prefix:MISS
Other - First Name:KANDI
Other - Middle Name:DENISE
Other - Last Name:BACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2520 E. DUPONT RD
Mailing Address - Street 2:NUTRITION SERVICES
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-416-3263
Mailing Address - Fax:260-416-3304
Practice Address - Street 1:2520 E. DUPONT RD
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-416-3263
Practice Address - Fax:260-416-3304
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000663A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered