Provider Demographics
NPI:1356137665
Name:HOLSTEIN, HANNAH (RDN, LD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HOLSTEIN
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 APPLE BLOSSOM LOOP
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72944-9445
Mailing Address - Country:US
Mailing Address - Phone:479-900-2940
Mailing Address - Fax:
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-314-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered