Provider Demographics
NPI:1710129598
Name:RATHBUN, ANNA (CN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6781 ROAD 19
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95456
Mailing Address - Country:US
Mailing Address - Phone:707-937-0476
Mailing Address - Fax:707-937-0476
Practice Address - Street 1:45015 UKIAH STREET
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-937-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education