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General NPI Number Information
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NPI Number | 1558071639
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Entity Type | Individual
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Provider Name | ANYA DISSEN RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 41 DONALD B DEAN DR STE A
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-3252
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Country | US
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Telephone | 207-661-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 240 HARVARD ST APT 607
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City | PORTLAND
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State | ME
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Zip | 04103-3536
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Country | US
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Telephone | 410-310-7343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI1621
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License Number State | ME
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