Provider Demographics
NPI:1447672894
Name:NELSON, ANNETTA (RD)
Entity type:Individual
Prefix:
First Name:ANNETTA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 LAGO AVE
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6814
Mailing Address - Country:US
Mailing Address - Phone:337-351-0525
Mailing Address - Fax:337-662-2298
Practice Address - Street 1:345 LAGO AVE
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6814
Practice Address - Country:US
Practice Address - Phone:337-351-0525
Practice Address - Fax:337-662-2298
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered