Individual
KAYLA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
4614 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3520
(336) 716-6099
Mailing address
MEDICAL CENTER BLVD., WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L005928
NC
Other
Enumeration date
09/13/2019
Last updated
10/08/2019
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