Provider Demographics
NPI:1467703744
Name:SMITH, JEANNE WALSH (RD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:WALSH
Last Name:SMITH
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 1:2345 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8601
Mailing Address - Country:US
Mailing Address - Phone:610-250-9659
Mailing Address - Fax:
Practice Address - Street 1:2345 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8601
Practice Address - Country:US
Practice Address - Phone:610-250-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004816133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered