Provider Demographics
NPI:1043729981
Name:PRATT, ANNALISE MARIE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ANNALISE
Middle Name:MARIE
Last Name:PRATT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:ANNALISE
Other - Middle Name:MARIE
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1047 EAGLE DR APT 502
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5857
Mailing Address - Country:US
Mailing Address - Phone:330-592-2467
Mailing Address - Fax:
Practice Address - Street 1:3088 WADSWORTH RD STE 12
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-5265
Practice Address - Country:US
Practice Address - Phone:330-592-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8069133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered