Provider Demographics
NPI:1538333455
Name:SCHABEN, JENNA MARIE (RD LD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:SCHABEN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:IA
Mailing Address - Zip Code:51527
Mailing Address - Country:US
Mailing Address - Phone:712-748-3494
Mailing Address - Fax:
Practice Address - Street 1:311 S CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3038
Practice Address - Country:US
Practice Address - Phone:712-792-3581
Practice Address - Fax:712-792-2124
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001807133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001807OtherIOWA LICENSE