MEDICARE: KAROL HANSON RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	4381709	ID

General Provider Information

NPI Number	:	1396677902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROL HANSON RD

Provider Business Mailing Address
First Line	:	2052 N LARK PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-3326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2052 N LARK PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-3326
Country	:	US
Telephone Number	:	669-285-7253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ KAROL HANSON RD” Practice Location

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