Provider Demographics
NPI:1003122060
Name:POKORNY, ANNE MARY (RD, LD, MHA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARY
Last Name:POKORNY
Suffix:
Gender:F
Credentials:RD, LD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-335-2293
Mailing Address - Fax:252-331-2387
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE K
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-335-2293
Practice Address - Fax:252-331-2387
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered