Provider Demographics
NPI:1578024378
Name:MACAULEY, ANNA MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:MACAULEY
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 1:1155 MILL ST # MS 14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:
Practice Address - Street 1:75 PRINGLE WAY STE 505
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1469
Practice Address - Country:US
Practice Address - Phone:775-982-5437
Practice Address - Fax:775-982-3895
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39518-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered