Provider Demographics
NPI:1366818262
Name:JACKSON-HOLZHAUER, KAREN ANN (RD,FAND)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:JACKSON-HOLZHAUER
Suffix:
Gender:F
Credentials:RD,FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E LAFAYETTE ST
Mailing Address - Street 2:SUITE 2206
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2905
Mailing Address - Country:US
Mailing Address - Phone:313-727-4931
Mailing Address - Fax:
Practice Address - Street 1:1300 E LAFAYETTE ST
Practice Address - Street 2:SUITE 2206
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2905
Practice Address - Country:US
Practice Address - Phone:313-727-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered