Individual
JONI K. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MNT
Contact information
Practice address
933 E PIERCE ST, COUNCIL BLUFFS, IA 51503-4626
(712) 396-6828
(712) 396-4275
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
01034
IA
133V00000X
Registered Dietitian
335
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01034
IOWA DIETETIC LICENSE
IA
01
—
335
MEDICAL NUTRITION THERAPIST LICENSE
NE
01
—
803260
COMMISSION ON DIETETIC REGISTRATION CERTIFICATION
IA
Enumeration date
01/19/2017
Last updated
03/09/2017
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