Provider Demographics
NPI:1568122257
Name:WASHINGTON, ANNETTE MONIQUE (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MONIQUE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 VISTA DEL MAR WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5984
Mailing Address - Country:US
Mailing Address - Phone:951-764-4450
Mailing Address - Fax:
Practice Address - Street 1:1602 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4128
Practice Address - Country:US
Practice Address - Phone:318-626-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2904133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered