Healthcare Provider Details

I. General information

NPI: 1518332204
Provider Name (Legal Business Name): ANGELA JEAN HASEMANN RDN, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGIE HASEMANN RDN, CSP

II. Dates (important events)

Enumeration Date: 12/06/2015
Last Update Date: 12/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 TRAILRIDGE RD
CHARLOTTESVILLE VA
22903-4024
US

IV. Provider business mailing address

1617 TRAILRIDGE RD
CHARLOTTESVILLE VA
22903-4024
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-2522
  • Fax:
Mailing address:
  • Phone: 434-982-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: