Provider Demographics
NPI:1275856239
Name:MARTIN, JANA LEE (RD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:LEE
Other - Last Name:JANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:7101 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1619
Mailing Address - Country:US
Mailing Address - Phone:320-237-5952
Mailing Address - Fax:
Practice Address - Street 1:7101 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55428-1619
Practice Address - Country:US
Practice Address - Phone:320-237-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN980124133V00000X
MN980124133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered