Healthcare Provider Details

I. General information

NPI: 1265935712
Provider Name (Legal Business Name): ANNE GANJE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 WEST BROAD STREET SUITE 400
RICHMOND VA
23230
US

IV. Provider business mailing address

PO BOX 13289
DURHAM NC
27709
US

V. Phone/Fax

Practice location:
  • Phone: 804-774-4550
  • Fax:
Mailing address:
  • Phone: 505-923-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86040106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: