Healthcare Provider Details

I. General information

NPI: 1962770354
Provider Name (Legal Business Name): ANNE LENORE HAGUE PHD, MS, RD, LD, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 GREEN MEADOWS DR S
LEWIS CENTER OH
43035-9458
US

IV. Provider business mailing address

171 GREEN MEADOWS DR S
LEWIS CENTER OH
43035-9458
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-6569
  • Fax: 614-985-6568
Mailing address:
  • Phone: 614-985-6569
  • Fax: 614-985-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number6751
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: