Individual
DR. ANDREA BETH BONTRAGER YODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, RDN, CD
Contact information
Practice address
1627 E BRISTOL ST, ELKHART, IN 46514-3817
(574) 262-0313
(574) 389-4879
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37002566A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236040319
MEDICARE PTAN
IN
Enumeration date
04/17/2019
Last updated
03/31/2021
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