Provider Demographics
NPI:1780170688
Name:HANSON, ANDREA JEAN (MS, RDN, LN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, RDN, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S LAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1917
Mailing Address - Country:US
Mailing Address - Phone:605-759-7642
Mailing Address - Fax:
Practice Address - Street 1:1325 S CLIFF AVE OFC 1504A
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0630133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered