Provider Demographics
NPI:1821535550
Name:ANDERSON, JONI K (MNT)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-6828
Practice Address - Fax:712-396-4275
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01034133V00000X
NE335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA803260OtherCOMMISSION ON DIETETIC REGISTRATION CERTIFICATION
NE335OtherMEDICAL NUTRITION THERAPIST LICENSE
IA01034OtherIOWA DIETETIC LICENSE
IA01034OtherIOWA DIETETIC LICENSE