Provider Demographics
NPI:1063035004
Name:HINSON, CHRISANN M (RD/LD)
Entity Type:Individual
Prefix:
First Name:CHRISANN
Middle Name:M
Last Name:HINSON
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 1:4716 W QUAKER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5042
Mailing Address - Country:US
Mailing Address - Phone:805-345-0894
Mailing Address - Fax:
Practice Address - Street 1:4716 W QUAKER RIDGE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5042
Practice Address - Country:US
Practice Address - Phone:805-345-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered