Provider Demographics
NPI:1477371797
Name:ANNA, CASEY ANN (RD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:ANNA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-6904
Mailing Address - Country:US
Mailing Address - Phone:814-341-8768
Mailing Address - Fax:
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4305
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86110429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered