Provider Demographics
NPI:1053046532
Name:KAUFMAN, JAQUELINE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GENETIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:675 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1473
Mailing Address - Country:US
Mailing Address - Phone:330-491-6138
Mailing Address - Fax:
Practice Address - Street 1:675 S MONROE ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1473
Practice Address - Country:US
Practice Address - Phone:330-491-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-2289133V00000X
OHLD08510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered