Provider Demographics
NPI:1033973763
Name:DEMCZAR, JESSICA (LN, CNS, MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DEMCZAR
Suffix:
Gender:F
Credentials:LN, CNS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CULLMAN AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-0045
Mailing Address - Country:US
Mailing Address - Phone:845-489-7631
Mailing Address - Fax:
Practice Address - Street 1:3020 CULLMAN AVE APT 302
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-0045
Practice Address - Country:US
Practice Address - Phone:845-489-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNU000022133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist