Provider Demographics
NPI:1235303173
Name:MASSENBURG, JANA OSBORNE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:OSBORNE
Last Name:MASSENBURG
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MRS
Other - First Name:JANA
Other - Middle Name:KAY
Other - Last Name:MASSENBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,RD,LD
Mailing Address - Street 1:3620 GREEN VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-6513
Mailing Address - Country:US
Mailing Address - Phone:256-413-7087
Mailing Address - Fax:
Practice Address - Street 1:3620 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-6513
Practice Address - Country:US
Practice Address - Phone:256-413-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered