Provider Demographics
NPI:1578013058
Name:BESEMER, JENNIFER N (RD, CDE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:BESEMER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:AGOSTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 N EDDY ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3096
Mailing Address - Country:US
Mailing Address - Phone:574-237-9331
Mailing Address - Fax:574-237-9252
Practice Address - Street 1:211 N EDDY ST.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-237-9331
Practice Address - Fax:574-237-9252
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002583A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered