Provider Demographics
NPI:1760571616
Name:DUMONT, JENNINE FRANCES (RD)
Entity Type:Individual
Prefix:MISS
First Name:JENNINE
Middle Name:FRANCES
Last Name:DUMONT
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 1:54 N MAIN ST
Mailing Address - Street 2:BOX 397
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585
Mailing Address - Country:US
Mailing Address - Phone:508-867-9367
Mailing Address - Fax:
Practice Address - Street 1:54 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585
Practice Address - Country:US
Practice Address - Phone:508-867-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2295133NN1002X, 133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal