Provider Demographics
NPI:1295994093
Name:LASSWELL, ANITA DIANE (PHD, RD, LDN)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:DIANE
Last Name:LASSWELL
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-3938
Mailing Address - Country:US
Mailing Address - Phone:772-770-3752
Mailing Address - Fax:772-567-3855
Practice Address - Street 1:2925 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3097
Practice Address - Country:US
Practice Address - Phone:772-299-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3975133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered