Provider Demographics
NPI:1730253865
Name:CONDER-ELLIOTT, VICKY RENEE (RD)
Entity type:Individual
Prefix:DR
First Name:VICKY
Middle Name:RENEE
Last Name:CONDER-ELLIOTT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 MOON MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-5376
Mailing Address - Country:US
Mailing Address - Phone:928-758-8465
Mailing Address - Fax:
Practice Address - Street 1:2044 MOON MOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-5376
Practice Address - Country:US
Practice Address - Phone:928-758-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered