Provider Demographics
NPI:1356926315
Name:EGAN, ANIA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:ANIA
Middle Name:MARIE
Last Name:EGAN
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 1:84 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3776
Mailing Address - Country:US
Mailing Address - Phone:508-641-3730
Mailing Address - Fax:
Practice Address - Street 1:84 GRANT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3776
Practice Address - Country:US
Practice Address - Phone:508-641-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0134240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered