Provider Demographics
NPI:1710237771
Name:HATFIELD, JEANNE (RD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JEANNE
Other - Middle Name:CHRISITINE
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:4236 ARCH DR
Mailing Address - Street 2:108
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3210
Mailing Address - Country:US
Mailing Address - Phone:954-235-1111
Mailing Address - Fax:818-358-4704
Practice Address - Street 1:4236 ARCH DR
Practice Address - Street 2:108
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3210
Practice Address - Country:US
Practice Address - Phone:954-235-1111
Practice Address - Fax:818-358-4704
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL888692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered