Provider Demographics
NPI:1609313766
Name:HIRSCHBRUNNER, SALENA (RD)
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
Last Name:HIRSCHBRUNNER
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 1:9200 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5976
Mailing Address - Country:US
Mailing Address - Phone:402-770-1909
Mailing Address - Fax:
Practice Address - Street 1:9200 S 28TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5976
Practice Address - Country:US
Practice Address - Phone:402-770-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE644133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered