Provider Demographics
NPI:1457503690
Name:ROGER, JEANETTE (RD)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:ROGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 TAYLOR ST DEPT OF
Mailing Address - Street 2:NUTRITION DEPARTMENT - 2C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-870-0011
Mailing Address - Fax:313-876-0539
Practice Address - Street 1:1151 TAYLOR ST DEPT OF
Practice Address - Street 2:NUTRITION DEPARTMENT - 2C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-870-0011
Practice Address - Fax:313-876-0539
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR260385014022133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered