Healthcare Provider Details

I. General information

NPI: 1326736398
Provider Name (Legal Business Name): ANNE MICHELLE PREJEAN PHD, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 PENWOOD RD
BASKING RIDGE NJ
07920-2220
US

IV. Provider business mailing address

43 PENWOOD RD
BASKING RIDGE NJ
07920-2220
US

V. Phone/Fax

Practice location:
  • Phone: 817-637-5136
  • Fax:
Mailing address:
  • Phone: 817-637-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3742
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164011180
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT84914
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number288511
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3316
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: