Provider Demographics
NPI:1588498521
Name:HITZMAN, SHANNON (RDN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HITZMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 BEACH BURR CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3307
Mailing Address - Country:US
Mailing Address - Phone:702-419-1379
Mailing Address - Fax:
Practice Address - Street 1:1072 BEACH BURR CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-3307
Practice Address - Country:US
Practice Address - Phone:702-419-1379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39706-DI-2133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered