Provider Demographics
NPI:1215272760
Name:HANSON, JENNIFER A (RD, LD,)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:RD, LD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCHOOL OF HUMAN ECOLOGY
Mailing Address - Street 2:P.O. BOX 3167
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71272-0001
Mailing Address - Country:US
Mailing Address - Phone:318-257-2370
Mailing Address - Fax:318-257-4014
Practice Address - Street 1:600 CAISSON HILL RD
Practice Address - Street 2:NUTRITION CARE
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:785-239-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1271133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered