Provider Demographics
NPI:1386191948
Name:HAUGE, VANESSA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:HAUGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 FRANCE AVE. S
Mailing Address - Street 2:FAIRVIEW SOUTHDALE HOSPITAL - NUTRITION SERVICES
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-924-5061
Mailing Address - Fax:952-924-1513
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:FAIRVIEW SOUTHDALE HOSPITAL - NUTRITION SERVICES
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-924-5061
Practice Address - Fax:952-924-1513
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3757133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered