Healthcare Provider Details

I. General information

NPI: 1063196079
Provider Name (Legal Business Name): ANNIE DUPRE RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CLEVELAND ST APT 3
WAKEFIELD RI
02879-3329
US

IV. Provider business mailing address

29 CLEVELAND ST APT 3
WAKEFIELD RI
02879-3329
US

V. Phone/Fax

Practice location:
  • Phone: 401-585-6305
  • Fax:
Mailing address:
  • Phone: 401-585-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN6632
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN1409
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: