MEDICARE: LISA HANHAUSER RD, LD

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	458	SC

General Provider Information

NPI Number	:	1922316546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HANHAUSER RD, LD

Provider Business Mailing Address
First Line	:	PO BOX 118008
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29423-8008
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	2500 ELMS CENTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5881

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

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	03/05/2014

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