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General NPI Number Information
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NPI Number | 1992974422
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Entity Type | Individual
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Provider Name | ANNETTE L. PEDERSEN RDN, LD, CDE
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Gender | Female
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 9417 BROADVIEW RD
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-2307
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Country | US
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Telephone | 330-388-7894
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Fax |
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Provider Business Mailing Address
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Address Line | 9417 BROADVIEW RD
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-2307
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Country | US
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Telephone | 330-388-7894
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 288780
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD2323
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License Number State | OH
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