Provider Demographics
NPI:1073910345
Name:MAHAN-WIEGAND, JANE L (MS, RD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:MAHAN-WIEGAND
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD
Mailing Address - Street 1:13527 OLD DAIRY ROAD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171
Mailing Address - Country:US
Mailing Address - Phone:703-606-5233
Mailing Address - Fax:
Practice Address - Street 1:1900 CAMPUS COMMONS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-606-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered