MEDICARE: MRS. NORA ELIZABETH JANSEN SHANK RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	DI100000843	DC
2	133V00000X	Registered Dietitian		VA

General Provider Information

NPI Number	:	1801084124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NORA ELIZABETH JANSEN SHANK RDN, LDN

Provider Business Mailing Address
First Line	:	6330 NICHOLSON ST
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-1741
Country	:	US
Telephone Number	:	571-385-2074
Fax Number	:	480-284-8275

Provider Business Practice Location Address
First Line	:	6330 NICHOLSON ST
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-1741
Country	:	US
Telephone Number	:	571-385-2074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	03/12/2024

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