Provider Demographics
NPI:1689143307
Name:GRINAKER, HANNA ELISABET (MS, RD)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:ELISABET
Last Name:GRINAKER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 FRANKLIN AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-3004
Mailing Address - Country:US
Mailing Address - Phone:218-841-1368
Mailing Address - Fax:
Practice Address - Street 1:2565 FRANKLIN AVE APT 405
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-3004
Practice Address - Country:US
Practice Address - Phone:218-841-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86032193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered