Provider Demographics
NPI:1770300022
Name:CONNORS, KELLI GUENTHER (RD, LDN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:GUENTHER
Last Name:CONNORS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3708
Mailing Address - Country:US
Mailing Address - Phone:410-684-9920
Mailing Address - Fax:
Practice Address - Street 1:744 SENECA DR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3708
Practice Address - Country:US
Practice Address - Phone:410-684-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered