Provider Demographics
NPI:1134288525
Name:BERZAI, ANNA C (RD)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:C
Last Name:BERZAI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 N MAIN ST UNIT 24A
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8845
Mailing Address - Country:US
Mailing Address - Phone:574-440-8700
Mailing Address - Fax:574-440-8701
Practice Address - Street 1:6910 N MAIN ST UNIT 24A
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8845
Practice Address - Country:US
Practice Address - Phone:574-440-8700
Practice Address - Fax:574-440-8701
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN976983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN37001740AOtherINDIANA CERTIFICATION #
IN976983OtherLICENSE NUMBER