Provider Demographics
NPI:1598818619
Name:PETTERSEN, JODI A (RD)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:A
Last Name:PETTERSEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 BASQUE WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7981
Mailing Address - Country:US
Mailing Address - Phone:775-720-3490
Mailing Address - Fax:775-888-9510
Practice Address - Street 1:783 BASQUE WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7981
Practice Address - Country:US
Practice Address - Phone:775-720-3490
Practice Address - Fax:775-888-9510
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered