Provider Demographics
NPI:1972107142
Name:BAUERLE, ANNA (RDN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BAUERLE
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 1:104 SPRING ST APT C11
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5356
Mailing Address - Country:US
Mailing Address - Phone:843-446-8739
Mailing Address - Fax:
Practice Address - Street 1:104 SPRING ST APT C11
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5356
Practice Address - Country:US
Practice Address - Phone:843-446-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC133V00000X
SC86107165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered