Provider Demographics
NPI:1306917448
Name:ANDERSON, HOPE H (RD)
Entity type:Individual
Prefix:MRS
First Name:HOPE
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:HOPE
Other - Middle Name:H
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1703 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5514
Mailing Address - Country:US
Mailing Address - Phone:847-681-1208
Mailing Address - Fax:847-681-8780
Practice Address - Street 1:1703 VIOLET CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5514
Practice Address - Country:US
Practice Address - Phone:847-681-1208
Practice Address - Fax:847-681-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL834136133V00000X
IL133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDOC ID 1028956OtherDOCTOR REFERAL FOR DIETET