Provider Demographics
NPI:1306211552
Name:MAKI, JENNIFER A (RD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MAKI
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 OAKVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1318
Mailing Address - Country:US
Mailing Address - Phone:763-639-1446
Mailing Address - Fax:
Practice Address - Street 1:1302 OAKVIEW WAY
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1318
Practice Address - Country:US
Practice Address - Phone:763-639-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2222133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered