Individual
MRS. CONNIE LOU HAYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LRD
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 232-3241
Mailing address
1218 2ND ST W, WEST FARGO, ND 58078-2617
(701) 282-6074
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
481
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
481
STATE LICENSE #
ND
Enumeration date
07/11/2006
Last updated
07/08/2007
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