Provider Demographics
NPI:1679545818
Name:CICHOCKI, ANNIE MAPANAO (REGISTERED DIETIAN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MAPANAO
Last Name:CICHOCKI
Suffix:
Gender:F
Credentials:REGISTERED DIETIAN
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:LALIN
Other - Last Name:MAPANAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:559 VINCENT ST
Mailing Address - Street 2:21ST MEDICAL GROUP SGHQ
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1060
Mailing Address - Fax:719-556-9677
Practice Address - Street 1:559 VINCENT ST
Practice Address - Street 2:
Practice Address - City:PETERSON AIR FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1060
Practice Address - Fax:719-556-9677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered