Provider Demographics
NPI:1932823549
Name:WILSON, HANNAH KATE (PHD, RDN, LRD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:KATE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD, RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4839 38TH ST S APT 303
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9132
Mailing Address - Country:US
Mailing Address - Phone:478-230-0809
Mailing Address - Fax:
Practice Address - Street 1:4839 38TH ST S APT 303
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9132
Practice Address - Country:US
Practice Address - Phone:478-230-0809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1317133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered