Provider Demographics
NPI:1538506084
Name:NOONAN-CONLON, MEGAN JANE (RD, LD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JANE
Last Name:NOONAN-CONLON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1420
Mailing Address - Country:US
Mailing Address - Phone:515-368-2233
Mailing Address - Fax:
Practice Address - Street 1:2400 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4664
Practice Address - Country:US
Practice Address - Phone:641-424-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002085133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered