Healthcare Provider Details

I. General information

NPI: 1407719438
Provider Name (Legal Business Name): LEANNA MATTHEWS RDN, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARY CIR
ANCHORAGE AK
99515-3339
US

IV. Provider business mailing address

500 MARY CIR
ANCHORAGE AK
99515-3339
US

V. Phone/Fax

Practice location:
  • Phone: 907-227-9361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number150262
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: