Provider Demographics
NPI:1679359731
Name:FERENTZ, ANNIE (RDN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:FERENTZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3324
Mailing Address - Country:US
Mailing Address - Phone:515-822-4304
Mailing Address - Fax:
Practice Address - Street 1:946 LEWIS ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3324
Practice Address - Country:US
Practice Address - Phone:515-822-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86328646133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered