Provider Demographics
NPI:1033716832
Name:OPALKO, ANNA (MPH, RD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:OPALKO
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PHILMAR CT APT B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3065
Mailing Address - Country:US
Mailing Address - Phone:717-395-4866
Mailing Address - Fax:
Practice Address - Street 1:504 PHILMAR CT APT B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3065
Practice Address - Country:US
Practice Address - Phone:717-395-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005703133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered