Gustafson, Anissa A

Gustafson, Anissa A is an individual health care provider with primary practice located at 3006 S Maryland Pkwy Suite 690, Las Vegas NV 89109-2218. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Gustafson, Anissa A can be contacted via phone (702) 732-1290.

Contact Information

Primary practice address
3006 S Maryland Pkwy Suite 690 Las Vegas NV 89109-2218
Phone: (702) 732-1290
Fax: (702) 732-0992
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 844704 Nevada

Profile Details

NPI number 1205059565
LBN Legal business name Gustafson, Anissa A
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205059565 NPPES
Nevada Other 844704 ADA MEMBERSHIP NUMBER

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