Healthcare Provider Details

I. General information

NPI: 1205564747
Provider Name (Legal Business Name): HANNAH LOUISE CHANDLER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N WYATT DR
TUCSON AZ
85712-6106
US

IV. Provider business mailing address

2624 N FREMONT AVE
TUCSON AZ
85719-3015
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5437
  • Fax:
Mailing address:
  • Phone: 520-906-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86172313
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: