Provider Demographics
NPI:1881238905
Name:LOCKHART, HANNAH MARIE (MPH, RDN)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:12168 MOUNT VERNON AVE UNIT 65
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5544
Mailing Address - Country:US
Mailing Address - Phone:951-990-0146
Mailing Address - Fax:
Practice Address - Street 1:11980 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5172
Practice Address - Country:US
Practice Address - Phone:951-492-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86115984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered