Provider Demographics
NPI:1164460440
Name:DOANE, JENNIFER MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:DOANE
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 1:961 MARCON BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-9371
Mailing Address - Country:US
Mailing Address - Phone:610-443-1885
Mailing Address - Fax:610-443-1685
Practice Address - Street 1:961 MARCON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9371
Practice Address - Country:US
Practice Address - Phone:610-443-1885
Practice Address - Fax:610-443-1685
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2378865OtherAETNA ID #
PA00774560Medicaid
PA2378865OtherAETNA ID #