Provider Demographics
NPI:1376511329
Name:MUSA, JENNIFER L (RD, CD, LD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MUSA
Suffix:
Gender:F
Credentials:RD, CD, LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:COUEY/BERRETJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:509-838-2531
Mailing Address - Fax:
Practice Address - Street 1:610 S SHERMAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1359
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8297855Medicaid