Provider Demographics
NPI:1942574454
Name:REDWINE, ANN ELIZABETH (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:REDWINE
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23400 KINGSLAND BLVD APT 5301
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7477
Mailing Address - Country:US
Mailing Address - Phone:501-515-2000
Mailing Address - Fax:
Practice Address - Street 1:5420 DASHWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5333
Practice Address - Country:US
Practice Address - Phone:713-486-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85778133V00000X
AR1283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered