Provider Demographics
NPI:1588236871
Name:BARTLES, JENNIFER (LMNT, RD, CDE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BARTLES
Suffix:
Gender:F
Credentials:LMNT, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 NORTHWOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2093
Mailing Address - Country:US
Mailing Address - Phone:402-484-3440
Mailing Address - Fax:
Practice Address - Street 1:8207 NORTHWOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2093
Practice Address - Country:US
Practice Address - Phone:402-484-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1539133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered