Provider Demographics
NPI:1821253790
Name:HANSEN, CANDECE DANYL (MS, RD, LMNT)
Entity Type:Individual
Prefix:
First Name:CANDECE
Middle Name:DANYL
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS, RD, LMNT
Other - Prefix:
Other - First Name:CANDECE
Other - Middle Name:DANYL
Other - Last Name:GOSHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LMNT
Mailing Address - Street 1:82863 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68779-7837
Mailing Address - Country:US
Mailing Address - Phone:402-439-2658
Mailing Address - Fax:
Practice Address - Street 1:710 S 13TH ST STE 1200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5606
Practice Address - Country:US
Practice Address - Phone:402-370-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE951529OtherCDR