Provider Demographics
NPI:1982923553
Name:EASTBURN, ANNA M (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:M
Last Name:EASTBURN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 LAFITTE ST
Mailing Address - Street 2:#102
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5218
Mailing Address - Country:US
Mailing Address - Phone:985-249-1017
Mailing Address - Fax:
Practice Address - Street 1:830 LAFITTE ST
Practice Address - Street 2:#102
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5218
Practice Address - Country:US
Practice Address - Phone:985-249-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2188133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered