Provider Demographics
NPI:1982838843
Name:HANSON, MICHELLE ANN (MA,RD,LD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1725
Mailing Address - Country:US
Mailing Address - Phone:507-581-3988
Mailing Address - Fax:715-808-8362
Practice Address - Street 1:716 VINE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1725
Practice Address - Country:US
Practice Address - Phone:507-581-3988
Practice Address - Fax:715-808-8362
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered