Individual
MISS SARA HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1358 E RICHARDS ST, TYLER, TX 75702-6153
(903) 531-9455
Mailing address
PO BOX 1238, TYLER, TX 75710-1238
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
#DT82562
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27-0954405
—
TX
Enumeration date
07/01/2014
Last updated
07/01/2014
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