Provider Demographics
NPI:1902382609
Name:CONRATH, CYNTHIA C
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:CONRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 21ST AVENUE SOUTH 607 MEDICAL ARTS BUILDING
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-1320
Mailing Address - Country:US
Mailing Address - Phone:615-322-6394
Mailing Address - Fax:615-936-3957
Practice Address - Street 1:1211 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2717
Practice Address - Country:US
Practice Address - Phone:615-322-6394
Practice Address - Fax:615-936-3957
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000871133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered