Provider Demographics
NPI:1568001832
Name:MABRY, JANICE LYNN (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LYNN
Last Name:MABRY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:LYNN
Other - Last Name:FORDYCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 S 13TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-4670
Mailing Address - Country:US
Mailing Address - Phone:720-425-7218
Mailing Address - Fax:
Practice Address - Street 1:1501 E 3RD ST # NA
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2815
Practice Address - Country:US
Practice Address - Phone:970-874-7681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological