Provider Demographics
NPI:1356789598
Name:CHAM-A-KOON, HANNAH C (RD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:C
Last Name:CHAM-A-KOON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:C
Other - Last Name:COWGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:232 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8053
Mailing Address - Country:US
Mailing Address - Phone:406-396-6556
Mailing Address - Fax:
Practice Address - Street 1:1101 26TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5161
Practice Address - Country:US
Practice Address - Phone:406-455-5000
Practice Address - Fax:406-455-4965
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19358133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist