Provider Demographics
NPI:1790917979
Name:DIETZ, JENNIFER (RD, CDE, LDN, MSPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:RD, CDE, LDN, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PINEY FOREST RD STE 306D
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2869
Mailing Address - Country:US
Mailing Address - Phone:434-548-0476
Mailing Address - Fax:434-791-3330
Practice Address - Street 1:625 PINEY FOREST RD STE 306D
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2869
Practice Address - Country:US
Practice Address - Phone:434-548-0476
Practice Address - Fax:434-791-3330
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001930133V00000X
VA862411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered