Provider Demographics
NPI:1144047259
Name:ANDERSON, DEREK J
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 POYDRAS ST STE 1770
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-5204
Mailing Address - Country:US
Mailing Address - Phone:877-212-7796
Mailing Address - Fax:
Practice Address - Street 1:1340 POYDRAS ST STE 1770
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-5204
Practice Address - Country:US
Practice Address - Phone:877-212-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-21
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist