Provider Demographics
NPI:1063691343
Name:CURTIS, ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:CURTIS
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 1:130 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2039
Mailing Address - Country:US
Mailing Address - Phone:814-371-5956
Mailing Address - Fax:814-371-5956
Practice Address - Street 1:130 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2039
Practice Address - Country:US
Practice Address - Phone:814-371-5956
Practice Address - Fax:814-371-5956
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015567080001Medicaid