Healthcare Provider Details

I. General information

NPI: 1427162916
Provider Name (Legal Business Name): KAREN DENISE HANSROTE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NUTRITION AND FOOD SERVICE PP VAMC
PERRY POINT MD
21902
US

IV. Provider business mailing address

50 WARREN DR
ELKTON MD
21921-4870
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-392-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD00988
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: