| Doctor Name: | MS. CONNIE JEAN WILDT |
| NPI Number: | 1356583504 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD,LD |
| License Number: | 2001024181 |
| Business Practice Address: | 615 S. New Ballas Rd St. Louis, MO - 631418221 |
| Business Phone Number: | 3142514998 |
| Business Fax Number: | 3142517247 |
| Mailing Address: | 615 S. New Ballas Road, St. John's Mercy Medical Center- Jfk Clinic ST. LOUIS |
| State: | MO |
| Postal Code: | 631418277 |
| Phone Number: | 3142514998 |
| Fax Number: | 3142517247 |
| NPI Enumeration Date: | 04/02/2009 |
| NPI Last Update Date: | 04/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 2001024181 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |