Provider Demographics
NPI:1558744011
Name:HUBER, JESSICA (RDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HUBER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 N TOWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-9466
Mailing Address - Country:US
Mailing Address - Phone:989-272-7237
Mailing Address - Fax:
Practice Address - Street 1:1040 N TOWERLINE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-9466
Practice Address - Country:US
Practice Address - Phone:989-272-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041572133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered