Provider Demographics
NPI:1407599426
Name:ANNA MARIE LONG NUTRITION LLC
Entity Type:Organization
Organization Name:ANNA MARIE LONG NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:903-390-6709
Mailing Address - Street 1:2941 YOUNGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5063
Mailing Address - Country:US
Mailing Address - Phone:903-390-6709
Mailing Address - Fax:
Practice Address - Street 1:8500 N MOPAC EXPY STE 901
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8348
Practice Address - Country:US
Practice Address - Phone:512-843-5781
Practice Address - Fax:877-775-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty