Provider Demographics
NPI:1871585323
Name:BLOCKER, ANNE M (MS, RDN, CSSD, LD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:BLOCKER
Suffix:
Gender:F
Credentials:MS, RDN, CSSD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-1530
Mailing Address - Country:US
Mailing Address - Phone:563-568-1824
Mailing Address - Fax:
Practice Address - Street 1:806 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2363
Practice Address - Country:US
Practice Address - Phone:563-794-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00636133V00000X, 133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15239Medicare ID - Type Unspecified
IA025190009Medicare PIN