Provider Demographics
NPI:1376849976
Name:HANSEN, LLC
Entity Type:Organization
Organization Name:HANSEN, LLC
Other - Org Name:FT COLLINS WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:970-581-3278
Mailing Address - Street 1:6615 DESERT WILLOW WAY
Mailing Address - Street 2:B3
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7804
Mailing Address - Country:US
Mailing Address - Phone:970-581-3278
Mailing Address - Fax:
Practice Address - Street 1:1224 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4007
Practice Address - Country:US
Practice Address - Phone:970-430-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO979816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty