Basic Information
| Provider Information | |||||||||
| NPI: | 1003948878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWARTZENDRUBER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5012 MEYERS ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486407202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899750832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 COURT ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893457000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 981122 | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.