Healthcare Provider Details

I. General information

NPI: 1215272760
Provider Name (Legal Business Name): JENNIFER A HANSON R.D., L.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CAISSON HILL RD NUTRITION CARE
FORT RILEY KS
66442-7037
US

IV. Provider business mailing address

SCHOOL OF HUMAN ECOLOGY P.O. BOX 3167
RUSTON LA
71272-0001
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7644
  • Fax:
Mailing address:
  • Phone: 318-257-2370
  • Fax: 318-257-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1271
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: