Provider Demographics
NPI:1194765818
Name:DEROCHER, ANNE JEANINE (CN)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:JEANINE
Last Name:DEROCHER
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2409
Mailing Address - Country:US
Mailing Address - Phone:518-372-4706
Mailing Address - Fax:518-346-5061
Practice Address - Street 1:1003 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2409
Practice Address - Country:US
Practice Address - Phone:518-372-4706
Practice Address - Fax:518-346-5061
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003778-1133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist