1821253790 NPI number — CANDECE DANYL HANSEN MS, RD, LMNT

Table of content: CANDECE DANYL HANSEN MS, RD, LMNT (NPI 1821253790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821253790 NPI number — CANDECE DANYL HANSEN MS, RD, LMNT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
CANDECE
Provider Middle Name:
DANYL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LMNT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOSHORN
Provider Other First Name:
CANDECE
Provider Other Middle Name:
DANYL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, LMNT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821253790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82863 HIGHWAY 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANTON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68779-7837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-439-2658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 S 13TH ST STE 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-370-4570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  829 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 951529 . This is a "CDR" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".