Provider Demographics
NPI:1003517277
Name:HANSEN, NORMAN ROBERT (RDN)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:ROBERT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1311
Mailing Address - Country:US
Mailing Address - Phone:215-900-0440
Mailing Address - Fax:
Practice Address - Street 1:861 GLENN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1311
Practice Address - Country:US
Practice Address - Phone:215-900-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered