Provider Demographics
NPI:1760807135
Name:AILTS, ANNE (MS, RD, LN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:AILTS
Suffix:
Gender:F
Credentials:MS, RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E. 20TH ST.
Mailing Address - Street 2:PLAZA 4, SUITE 200
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-322-3455
Mailing Address - Fax:605-322-3456
Practice Address - Street 1:911 E. 20TH ST.
Practice Address - Street 2:PLAZA 4, SUITE 200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-322-3455
Practice Address - Fax:605-322-3456
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered