Provider Demographics
NPI:1184227431
Name:AVANESYAN, ANISSA (RD)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:AVANESYAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANISSA
Other - Middle Name:
Other - Last Name:ALCAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2900 12TH AVE N STE 160W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7508
Mailing Address - Country:US
Mailing Address - Phone:406-237-8500
Mailing Address - Fax:406-237-8501
Practice Address - Street 1:2900 12TH AVE N STE 160W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7508
Practice Address - Country:US
Practice Address - Phone:406-237-8500
Practice Address - Fax:406-237-8501
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT91146133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist