Healthcare Provider Details

I. General information

NPI: 1801084124
Provider Name (Legal Business Name): NORA ELIZABETH JANSEN SHANK RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/12/2024
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 NICHOLSON ST
FALLS CHURCH VA
22044-1741
US

IV. Provider business mailing address

6330 NICHOLSON ST
FALLS CHURCH VA
22044-1741
US

V. Phone/Fax

Practice location:
  • Phone: 571-385-2074
  • Fax:
Mailing address:
  • Phone: 571-385-2074
  • Fax: 480-284-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDI100000843
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: