Provider Demographics
NPI:1801084124
Name:JANSEN SHANK, NORA ELIZABETH (RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:ELIZABETH
Last Name:JANSEN SHANK
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NICHOLSON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1741
Mailing Address - Country:US
Mailing Address - Phone:571-385-2074
Mailing Address - Fax:480-284-8275
Practice Address - Street 1:6330 NICHOLSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1741
Practice Address - Country:US
Practice Address - Phone:571-385-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000843133VN1201X
VA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management