Provider Demographics
NPI:1194474494
Name:NOAD, ANITA (RD LDN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:NOAD
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 1:3016 NEWSOM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2359
Mailing Address - Country:US
Mailing Address - Phone:407-535-2903
Mailing Address - Fax:
Practice Address - Street 1:3016 NEWSOM RIDGE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2359
Practice Address - Country:US
Practice Address - Phone:407-535-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84479133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered