Provider Demographics
NPI:1659990430
Name:MITCHELL, ANNA (RD, CSSD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 PATCHIN DR
Mailing Address - Street 2:
Mailing Address - City:NUNICA
Mailing Address - State:MI
Mailing Address - Zip Code:49448-9338
Mailing Address - Country:US
Mailing Address - Phone:616-481-9667
Mailing Address - Fax:
Practice Address - Street 1:13260 PATCHIN DR
Practice Address - Street 2:
Practice Address - City:NUNICA
Practice Address - State:MI
Practice Address - Zip Code:49448-9338
Practice Address - Country:US
Practice Address - Phone:616-481-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered