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General NPI Number Information
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NPI Number | 1780419853
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Entity Type | Individual
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Provider Name | HANNAH LYNN ENNIS RDN, LD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 45741 GRACE LAKE RD
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City | SANDSTONE
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State | MN
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Zip | 55072-3203
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Country | US
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Telephone | 320-384-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 18562 MINOBIMAADIZI LOOP
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City | ONAMIA
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State | MN
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Zip | 56359-3001
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Country | US
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Telephone | 320-532-7835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 5402
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License Number State | MN
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