Provider Demographics
NPI:1720417389
Name:GERALNICK, JACQUELINE A (MPH, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:GERALNICK
Suffix:
Gender:F
Credentials:MPH, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 MINTWOOD PL NW APT 106
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1934
Mailing Address - Country:US
Mailing Address - Phone:703-909-5434
Mailing Address - Fax:
Practice Address - Street 1:1843 MINTWOOD PL NW APT 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1934
Practice Address - Country:US
Practice Address - Phone:703-909-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000540133V00000X
MDDX3342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered