Provider Demographics
NPI:1982940979
Name:HANSON, SUZANNE ADELE (RD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ADELE
Last Name:HANSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:STUEBING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1516 EL VERANO WAY
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3625
Mailing Address - Country:US
Mailing Address - Phone:650-483-8653
Mailing Address - Fax:
Practice Address - Street 1:1516 EL VERANO WAY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3625
Practice Address - Country:US
Practice Address - Phone:650-483-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01056821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered