Provider Demographics
NPI:1497762553
Name:KANODE, ANDREA J (MS RD LDN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:J
Last Name:KANODE
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 WINELAND ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-1256
Mailing Address - Country:US
Mailing Address - Phone:814-793-7964
Mailing Address - Fax:
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:JAMES E VAN ZANDT VA MEDICAL CENTER
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4377
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:814-940-7862
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADN001585133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered