Provider Demographics
NPI:1518250968
Name:EARSLEY, ANNIE F (RD, CDE)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:F
Last Name:EARSLEY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:L
Other - Last Name:FRASSINELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MARCELA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-5760
Mailing Address - Country:US
Mailing Address - Phone:707-456-3001
Mailing Address - Fax:707-456-7313
Practice Address - Street 1:1 MARCELA DRIVE
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-5760
Practice Address - Country:US
Practice Address - Phone:707-456-3001
Practice Address - Fax:707-456-7313
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970872133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered