Provider Demographics
NPI:1013273242
Name:RDIABETES EMPOWERMNT LLC
Entity Type:Organization
Organization Name:RDIABETES EMPOWERMNT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDE
Authorized Official - Phone:410-487-2779
Mailing Address - Street 1:192A S SOUTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4026
Mailing Address - Country:US
Mailing Address - Phone:410-487-2779
Mailing Address - Fax:410-280-2278
Practice Address - Street 1:192A S SOUTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4026
Practice Address - Country:US
Practice Address - Phone:410-487-2779
Practice Address - Fax:410-280-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty