Provider Demographics
NPI:1275136715
Name:THORSEN, ANNE (MS,RD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:THORSEN
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 1:62368 JIG RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-8213
Mailing Address - Country:US
Mailing Address - Phone:719-331-2774
Mailing Address - Fax:
Practice Address - Street 1:62368 JIG RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-8213
Practice Address - Country:US
Practice Address - Phone:719-331-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1022822133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered