Healthcare Provider Details

I. General information

NPI: 1124123294
Provider Name (Legal Business Name): ANNE MARIE SCHANKE RD LD N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 05/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20889 MORADA CT
BOCA RATON FL
33433-1714
US

IV. Provider business mailing address

20889 MORADA CT
BOCA RATON FL
33433-1714
US

V. Phone/Fax

Practice location:
  • Phone: 561-445-7648
  • Fax: 561-487-5479
Mailing address:
  • Phone: 561-445-7648
  • Fax: 561-487-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND3246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: