Provider Demographics
NPI:1760804017
Name:PAVLINEC, JESSICA (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:PAVLINEC
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N KENTUCKY AVE
Mailing Address - Street 2:APT 202A
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2500
Mailing Address - Country:US
Mailing Address - Phone:630-461-6047
Mailing Address - Fax:
Practice Address - Street 1:551 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4441
Practice Address - Country:US
Practice Address - Phone:641-424-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered