Provider Demographics
NPI:1467179473
Name:HERRMANN, JENNIFER (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 MARSH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8708
Mailing Address - Country:US
Mailing Address - Phone:252-626-6652
Mailing Address - Fax:
Practice Address - Street 1:328 MARSH OAKS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8708
Practice Address - Country:US
Practice Address - Phone:252-626-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
940969133V00000X
L-17256174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered