Provider Demographics
NPI:1205378148
Name:GOLDEN, JENNIFER (RDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 W HAPPY VALLEY RD
Mailing Address - Street 2:#141-186
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 W HAPPY VALLEY RD
Practice Address - Street 2:#141-186
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-3289
Practice Address - Country:US
Practice Address - Phone:602-770-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86034638OtherCDR