Provider Demographics
NPI:1457544587
Name:HAUSEL, ANDREA BREKKE (RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:BREKKE
Last Name:HAUSEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 MONSERAT AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1448
Mailing Address - Country:US
Mailing Address - Phone:650-435-9545
Mailing Address - Fax:
Practice Address - Street 1:2734 MONSERAT AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1448
Practice Address - Country:US
Practice Address - Phone:650-435-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006374133N00000X
CA0913790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7PP21ZZZR1Medicare PIN