Provider Demographics
NPI:1912690157
Name:ANDERSON WELLNESS AND NUTRITION
Entity Type:Organization
Organization Name:ANDERSON WELLNESS AND NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:NEWT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:907-406-1753
Mailing Address - Street 1:8821 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4256
Mailing Address - Country:US
Mailing Address - Phone:907-406-1753
Mailing Address - Fax:
Practice Address - Street 1:8821 PIONEER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4256
Practice Address - Country:US
Practice Address - Phone:907-406-1753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty