Provider Demographics
NPI:1487852265
Name:KANTORAK, JENNIFER REBECCA (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:KANTORAK
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:REBECCA
Other - Last Name:WINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12300 MCCRACKEN ROAD
Mailing Address - Street 2:DIABETES CENTER
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-584-4377
Mailing Address - Fax:216-584-4372
Practice Address - Street 1:12300 MCCRACKEN ROAD
Practice Address - Street 2:DIABETES CENTER
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-584-4377
Practice Address - Fax:216-584-4372
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered