Provider Demographics
NPI:1518018084
Name:MINDER, KAREN MAE (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MAE
Last Name:MINDER
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 COLIBRI AVE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7441
Mailing Address - Country:US
Mailing Address - Phone:505-865-4187
Mailing Address - Fax:
Practice Address - Street 1:1261 COLIBRI AVE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7441
Practice Address - Country:US
Practice Address - Phone:505-865-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP70684Medicare UPIN