Provider Demographics
NPI:1629272513
Name:HANDELAND, VERONICA ANNE (MPH,RD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANNE
Last Name:HANDELAND
Suffix:
Gender:F
Credentials:MPH,RD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:ANNE
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 WASHINGTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-4300
Mailing Address - Country:US
Mailing Address - Phone:605-384-3621
Mailing Address - Fax:605-384-3293
Practice Address - Street 1:111 WASHINGTON AVE NW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-4300
Practice Address - Country:US
Practice Address - Phone:605-384-3621
Practice Address - Fax:605-384-3293
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD953011133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5540100Medicaid
SDHSZ059Medicare ID - Type Unspecified