Provider Demographics
NPI:1124366018
Name:GRAEBER, ANN E (MS, RD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:GRAEBER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WINGED FOOT CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8053
Mailing Address - Country:US
Mailing Address - Phone:870-219-2707
Mailing Address - Fax:870-203-0794
Practice Address - Street 1:1416 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4362
Practice Address - Country:US
Practice Address - Phone:870-207-7826
Practice Address - Fax:870-207-6709
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered