Provider Demographics
NPI:1730625328
Name:HARTMAN, ANNA MINTER (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MINTER
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 WIDGEON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1111
Mailing Address - Country:US
Mailing Address - Phone:502-432-3969
Mailing Address - Fax:
Practice Address - Street 1:3113 WIDGEON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1111
Practice Address - Country:US
Practice Address - Phone:502-432-3969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY123875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered