Provider Demographics
NPI:1548814635
Name:HIGHTOWER, ANNALISA (LN)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123 PAESE PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5189
Mailing Address - Country:US
Mailing Address - Phone:505-255-6887
Mailing Address - Fax:
Practice Address - Street 1:7123 PAESE PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5189
Practice Address - Country:US
Practice Address - Phone:505-255-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLN-1289133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty