Provider Demographics
NPI:1326133059
Name:CRUSE, ANNE M (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:M
Last Name:CRUSE
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 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-351-3015
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:2545 S BRUCE ST STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1778
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-733-7876
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001696A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEU881ZMedicare PIN