Provider Demographics
NPI:1891237319
Name:NOLAND, JENNY CAI (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:CAI
Last Name:NOLAND
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50311
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0976
Mailing Address - Country:US
Mailing Address - Phone:541-255-5047
Mailing Address - Fax:
Practice Address - Street 1:85804 S WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-9555
Practice Address - Country:US
Practice Address - Phone:541-255-5047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113854897133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education