Healthcare Provider Details

I. General information

NPI: 1033711494
Provider Name (Legal Business Name): HANNAH GRACE NEAGO MS, RDN, LD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAIN DR
FAYETTEVILLE AR
72704-5292
US

IV. Provider business mailing address

2211 MAIN DR
FAYETTEVILLE AR
72704-5292
US

V. Phone/Fax

Practice location:
  • Phone: 479-485-1215
  • Fax: 833-605-1102
Mailing address:
  • Phone: 479-485-1215
  • Fax: 833-605-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1975
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: