MEDICARE: LEAH HANSEN RD, LD, MS

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	86329768	TX

General Provider Information

NPI Number	:	1912859174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH HANSEN RD, LD, MS

Provider Business Mailing Address
First Line	:	3902 CIMARRON BLVD APT 4306
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 CIMARRON BLVD APT 4306
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-4285
Country	:	US
Telephone Number	:	214-612-8484
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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