Provider Demographics
NPI:1902286727
Name:HANLEY, VISTA-DALE (RD)
Entity Type:Individual
Prefix:MS
First Name:VISTA-DALE
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 GROVE PARK DR
Mailing Address - Street 2:APT 211
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1594
Mailing Address - Country:US
Mailing Address - Phone:202-489-3570
Mailing Address - Fax:
Practice Address - Street 1:1448 GROVE PARK DR
Practice Address - Street 2:APT 211
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1594
Practice Address - Country:US
Practice Address - Phone:202-489-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered