Provider Demographics
NPI:1497932255
Name:JENNINGS, MARY E (RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE K
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-413-8121
Mailing Address - Fax:360-413-8865
Practice Address - Street 1:3525 ENSIGN ROAD NE
Practice Address - Street 2:SUITE K
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-413-8121
Practice Address - Fax:360-413-8865
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered