Provider Demographics
NPI:1578973319
Name:YANKER, CASSIE LYNN (RD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:LYNN
Last Name:YANKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 LAKE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3878
Mailing Address - Country:US
Mailing Address - Phone:719-561-5264
Mailing Address - Fax:719-561-5272
Practice Address - Street 1:3426 LAKE AVE STE 120
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3878
Practice Address - Country:US
Practice Address - Phone:719-561-5264
Practice Address - Fax:719-561-5272
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered