Provider Demographics
NPI:1255693743
Name:KANUCH, JENNIFER BETH (MS,RD,LDN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BETH
Last Name:KANUCH
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PLANE BANK RD
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938-5227
Mailing Address - Country:US
Mailing Address - Phone:814-241-6163
Mailing Address - Fax:
Practice Address - Street 1:191 PLANE BANK RD
Practice Address - Street 2:
Practice Address - City:LILLY
Practice Address - State:PA
Practice Address - Zip Code:15938-5227
Practice Address - Country:US
Practice Address - Phone:814-241-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered