Provider Demographics
NPI:1710424858
Name:KERNIZAN, HANNAH (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:KERNIZAN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1308
Mailing Address - Country:US
Mailing Address - Phone:484-241-5792
Mailing Address - Fax:484-241-5792
Practice Address - Street 1:166 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1308
Practice Address - Country:US
Practice Address - Phone:484-241-5792
Practice Address - Fax:484-241-5792
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4240133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered