Provider Demographics
NPI:1093267247
Name:HART, JENNA (RD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W CHANDLER BLVD STE 15-255
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6213
Mailing Address - Country:US
Mailing Address - Phone:480-745-8577
Mailing Address - Fax:480-745-8677
Practice Address - Street 1:1840 W CHANDLER BLVD STE D-2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6201
Practice Address - Country:US
Practice Address - Phone:480-745-8577
Practice Address - Fax:480-745-8677
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86059979133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered