Provider Demographics
NPI:1265974729
Name:MITTNACHT, ANNE MCRAE (MPH, RD, LDN, CEDRD)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MCRAE
Last Name:MITTNACHT
Suffix:
Gender:F
Credentials:MPH, RD, LDN, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 IDEAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5625
Mailing Address - Country:US
Mailing Address - Phone:609-577-6791
Mailing Address - Fax:
Practice Address - Street 1:111 MIDDLESEX TPKE # 1107
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4905
Practice Address - Country:US
Practice Address - Phone:617-942-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN4425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered