Individual
AMY J HANOVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1100 S CEDAR ST, MASON, MI 48854-2086
(517) 484-3000
(517) 484-6358
Mailing address
1560 TURF LN, EAST LANSING, MI 48823-6392
(517) 484-3000
(517) 484-6358
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
816366
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
816366
COMMISSION ON DIETETIC REGISTRATION
MI
Enumeration date
02/28/2019
Last updated
02/28/2019
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