Provider Demographics
NPI:1235207481
Name:GEORGE, JESSICA LYNNE (RD LD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:DUNBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:11040 NORTH STATE ROAD 77
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3606
Mailing Address - Country:US
Mailing Address - Phone:715-934-4244
Mailing Address - Fax:320-255-5714
Practice Address - Street 1:1200 6TH AVENUE NORTH
Practice Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-656-7020
Practice Address - Fax:320-255-5714
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN887483133V00000X
MN2308133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered