Provider Demographics
NPI:1467888214
Name:WILTZER KARIM, JENNA L (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:WILTZER KARIM
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34055 SOLON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2662
Mailing Address - Country:US
Mailing Address - Phone:440-914-7840
Mailing Address - Fax:440-914-7855
Practice Address - Street 1:34055 SOLON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2662
Practice Address - Country:US
Practice Address - Phone:440-914-7840
Practice Address - Fax:440-914-7855
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1074622133V00000X
OH7051133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1074622OtherREGISTERED DIETITIAN
OH1144109OtherUNIVERSITY HOSPITALS EMPLOYEE ID
OH7051OtherLICENCED