Healthcare Provider Details

I. General information

NPI: 1962020677
Provider Name (Legal Business Name): JORDYN HAUSER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1212 TITUS AVE
DES MOINES IA
50315-3839
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-3121
  • Fax:
Mailing address:
  • Phone: 515-556-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: