Provider Demographics
NPI:1528377249
Name:WILFONG, ANNE L (RD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:L
Last Name:WILFONG
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 1:303 REVEILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5337
Mailing Address - Country:US
Mailing Address - Phone:512-843-1681
Mailing Address - Fax:737-443-5958
Practice Address - Street 1:303 REVEILLE RD
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5337
Practice Address - Country:US
Practice Address - Phone:512-843-1681
Practice Address - Fax:737-443-5958
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered