Provider Demographics
NPI:1477031128
Name:COAKLEY, HANNAH (RDN, LDN, MSPH)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:RDN, LDN, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 W VINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-1508
Mailing Address - Country:US
Mailing Address - Phone:301-651-0333
Mailing Address - Fax:
Practice Address - Street 1:1031 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3926
Practice Address - Country:US
Practice Address - Phone:301-651-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered