Provider Demographics
NPI:1356889828
Name:MANELLA, HANNAH M (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:M
Last Name:MANELLA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:M
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3143
Mailing Address - Country:US
Mailing Address - Phone:312-695-0990
Mailing Address - Fax:312-664-5854
Practice Address - Street 1:676 N SAINT CLAIR ST STE 2140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3143
Practice Address - Country:US
Practice Address - Phone:312-695-0990
Practice Address - Fax:312-664-5854
Is Sole Proprietor?:No
Enumeration Date:2017-02-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered