Provider Demographics
NPI:1558779405
Name:HANSEN, JOYANNA GILMOUR (PHD, RD)
Entity Type:Individual
Prefix:DR
First Name:JOYANNA
Middle Name:GILMOUR
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:JOYANNA
Other - Middle Name:FAITH
Other - Last Name:GILMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 SW GAINES ST
Mailing Address - Street 2:GH214
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2904
Mailing Address - Country:US
Mailing Address - Phone:503-494-4263
Mailing Address - Fax:
Practice Address - Street 1:840 SW GAINES ST
Practice Address - Street 2:GH214
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2904
Practice Address - Country:US
Practice Address - Phone:503-494-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10164627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered