Provider Demographics
NPI:1790717924
Name:ACKERMAN, JAMI LEE (RDN LDN)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:LEE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SAGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1355
Mailing Address - Country:US
Mailing Address - Phone:717-512-6230
Mailing Address - Fax:
Practice Address - Street 1:31 SAGECREST CIR
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1355
Practice Address - Country:US
Practice Address - Phone:717-512-6230
Practice Address - Fax:717-512-6230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003505133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN003505OtherSTATE LIC NUMBER