Provider Demographics
NPI:1780252296
Name:BAER, HANNAH MARIE (RDN, LD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:BAER
Suffix:
Gender:F
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 1:110 WINTERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2774
Mailing Address - Country:US
Mailing Address - Phone:904-477-0117
Mailing Address - Fax:
Practice Address - Street 1:299 E PEARL ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3606
Practice Address - Country:US
Practice Address - Phone:864-560-4231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2230133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered