Provider Demographics
NPI:1679196646
Name:GATES, HANNAH (RDN)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 ROYAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9101
Mailing Address - Country:US
Mailing Address - Phone:530-409-9187
Mailing Address - Fax:
Practice Address - Street 1:2887 ROYAL PARK DR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9101
Practice Address - Country:US
Practice Address - Phone:530-409-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered