Provider Demographics
NPI:1245608009
Name:BERMANN, ANITA C (RDN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:C
Last Name:BERMANN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 CURTIS LOOP NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5100
Mailing Address - Country:US
Mailing Address - Phone:206-913-8715
Mailing Address - Fax:
Practice Address - Street 1:403 MADISON AVE N STE 240
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2822
Practice Address - Country:US
Practice Address - Phone:206-913-8715
Practice Address - Fax:253-365-6299
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60600262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60600262OtherWASHINGTON DEPARTMENT OF HEALTH DIETITIAN CERTIFICATION