Provider Demographics
NPI:1033939210
Name:CONNER, AMBER LYNN (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:CONNER
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2706
Mailing Address - Country:US
Mailing Address - Phone:610-570-8121
Mailing Address - Fax:
Practice Address - Street 1:249 CHARLES AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2706
Practice Address - Country:US
Practice Address - Phone:610-570-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86392701133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics