Provider Demographics
NPI:1346989340
Name:JEAN-PAUL, JUNIOR (MS,CNS, CNGS)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:
Last Name:JEAN-PAUL
Suffix:
Gender:M
Credentials:MS,CNS, CNGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CHRISTINA LANDING DR APT 807
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5461
Mailing Address - Country:US
Mailing Address - Phone:646-469-4477
Mailing Address - Fax:
Practice Address - Street 1:115 CHRISTINA LANDING DR APT 807
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5461
Practice Address - Country:US
Practice Address - Phone:646-469-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0010856133NN1002X
PADN007582133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education