Provider Demographics
NPI:1225754245
Name:PYE WITTENBERG, JESSICA MARIE (RDN, LN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:PYE WITTENBERG
Suffix:
Gender:F
Credentials:RDN, LN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:PYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LN
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0763
Mailing Address - Country:US
Mailing Address - Phone:406-579-2934
Mailing Address - Fax:
Practice Address - Street 1:121 E HUGEL ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9074
Practice Address - Country:US
Practice Address - Phone:406-579-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT900945133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered