Provider Demographics
NPI:1306490784
Name:MOSELLE, ANNE M (MS, RD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MOSELLE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 KIM CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5117
Mailing Address - Country:US
Mailing Address - Phone:925-200-9884
Mailing Address - Fax:
Practice Address - Street 1:4625 1ST ST STE 260
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7170
Practice Address - Country:US
Practice Address - Phone:925-200-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered