Provider Demographics
NPI:1881113843
Name:ANDERSON, HANNAH (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 PADDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8739
Mailing Address - Country:US
Mailing Address - Phone:704-340-3019
Mailing Address - Fax:
Practice Address - Street 1:11301 CARMEL COMMONS BLVD STE 108
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5305
Practice Address - Country:US
Practice Address - Phone:980-677-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86096461133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered