Provider Demographics
NPI:1255817052
Name:DE JESUS, ANNA (RDN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DE JESUS
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:PO BOX 14143
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0070
Mailing Address - Country:US
Mailing Address - Phone:602-819-8394
Mailing Address - Fax:888-550-4813
Practice Address - Street 1:203 W GREENTREE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3002
Practice Address - Country:US
Practice Address - Phone:602-819-8394
Practice Address - Fax:888-550-4813
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered