Provider Demographics
NPI:1780780411
Name:BONPENSIERO, ANN (CDE/ RD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BONPENSIERO
Suffix:
Gender:F
Credentials:CDE/ RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-818-3616
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:13644 N SANDARIO RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-8579
Practice Address - Country:US
Practice Address - Phone:520-682-4111
Practice Address - Fax:520-682-3817
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ719248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered