Provider Demographics
NPI:1730366071
Name:ANDERSON, CHRISTINE RENEE (RD)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5154
Mailing Address - Country:US
Mailing Address - Phone:830-719-0400
Mailing Address - Fax:830-775-7291
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5154
Practice Address - Country:US
Practice Address - Phone:830-719-0400
Practice Address - Fax:830-775-7291
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT80793OtherLICENSE