Provider Demographics
NPI:1528367489
Name:ATHERTON, ANNE
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-1547
Mailing Address - Country:US
Mailing Address - Phone:785-263-3646
Mailing Address - Fax:785-263-3689
Practice Address - Street 1:103 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-1547
Practice Address - Country:US
Practice Address - Phone:785-263-3646
Practice Address - Fax:785-263-3689
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered