Provider Demographics
NPI:1568128346
Name:PETERSEN, ANNA CATHERINE (MS RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:CATHERINE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:CATHERINE
Other - Last Name:JURMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD LDW
Mailing Address - Street 1:1533 LARK LANE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:815-210-1517
Mailing Address - Fax:
Practice Address - Street 1:1533 LARK LANE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:815-210-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered