Basic Information
| Provider Information | |||||||||
| NPI: | 1881647907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EHLERT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 N HARRISON ST | ||||||||
| Address2: | COVENANT CENTRAL BUSINESS OFFICE - MICHIGAN CAMPUS | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895832963 | ||||||||
| FaxNumber: | 9895832811 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 MACKINAW RD | ||||||||
| Address2: | SUITE 3101 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486049515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895835186 | ||||||||
| FaxNumber: | 9895835226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | MI | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.