Healthcare Provider Details

I. General information

NPI: 1518680933
Provider Name (Legal Business Name): BRANDON JOHN HANSON MS, RD, LMNT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W LEOTA ST
NORTH PLATTE NE
69101-6525
US

IV. Provider business mailing address

620 GILMAN AVE
NORTH PLATTE NE
69101-5879
US

V. Phone/Fax

Practice location:
  • Phone: 308-568-8000
  • Fax:
Mailing address:
  • Phone: 308-750-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number971
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: