Provider Demographics
NPI:1720457708
Name:HUDSON, ANNA LEE (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MAXWELL AVE F
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2641
Mailing Address - Country:US
Mailing Address - Phone:864-715-2445
Mailing Address - Fax:
Practice Address - Street 1:128 MAXWELL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2641
Practice Address - Country:US
Practice Address - Phone:864-715-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered