Provider Demographics
NPI:1467474577
Name:ANSELMO, JANET M (RD, MS, LD, CDE, BC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:M
Last Name:ANSELMO
Suffix:
Gender:F
Credentials:RD, MS, LD, CDE, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3076
Mailing Address - Country:US
Mailing Address - Phone:440-439-1821
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:LOUIS STOKES DVA MED CTR 120 W
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-707-6414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2265133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered