Provider Demographics
NPI:1083430235
Name:HANSON, COLETON JOSHUA DOTSON (RDN)
Entity type:Individual
Prefix:MR
First Name:COLETON
Middle Name:JOSHUA DOTSON
Last Name:HANSON
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:MR
Other - First Name:COLE
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1609 SHERBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2245
Mailing Address - Country:US
Mailing Address - Phone:612-466-0331
Mailing Address - Fax:
Practice Address - Street 1:1609 SHERBURNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2245
Practice Address - Country:US
Practice Address - Phone:612-466-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91462133V00000X
MN4421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered