Provider Demographics
NPI:1679120695
Name:VANVELDHUISEN, JENNA (RD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:VANVELDHUISEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:STEENSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 PARCHMENT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1003 PARCHMENT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3664
Practice Address - Country:US
Practice Address - Phone:616-957-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86102233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered