Provider Demographics
NPI:1508185562
Name:HANAWALT, ELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HANAWALT
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:PO BOX 500202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-0202
Mailing Address - Country:US
Mailing Address - Phone:512-250-9140
Mailing Address - Fax:512-250-2207
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BLDG III, STE 220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-338-4500
Practice Address - Fax:512-338-4501
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04048133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104537Medicare PIN