Provider Demographics
NPI:1639859143
Name:EGGLESTON, JESSICA (MNT, RWP-1)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:MNT, RWP-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 POTOMAC ST STE 111
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6743
Mailing Address - Country:US
Mailing Address - Phone:303-343-3121
Mailing Address - Fax:
Practice Address - Street 1:750 POTOMAC ST STE 111
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6743
Practice Address - Country:US
Practice Address - Phone:303-343-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist