Provider Demographics
NPI:1376949057
Name:CONFORTINI, JENNIFER LYNN (RD, CD-N)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:CONFORTINI
Suffix:
Gender:F
Credentials:RD, CD-N
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:PYSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD-N
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST STE 720C
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3003
Practice Address - Country:US
Practice Address - Phone:864-560-6419
Practice Address - Fax:864-560-7498
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001142133V00000X
SC2123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ703766066OtherMEDICARE PIN
SCDT1205Medicaid