Provider Demographics
NPI:1952656654
Name:RIDER, ALYSSA ANNE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ANNE
Last Name:RIDER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2420
Mailing Address - Country:US
Mailing Address - Phone:309-854-2079
Mailing Address - Fax:
Practice Address - Street 1:621 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5405
Practice Address - Country:US
Practice Address - Phone:641-428-2320
Practice Address - Fax:641-428-6923
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001963133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered