Provider Demographics
NPI:1962024935
Name:GHERAU, JENNIFER L (RDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GHERAU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 TALL PINE LN APT 304
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-3190
Mailing Address - Country:US
Mailing Address - Phone:952-239-8422
Mailing Address - Fax:
Practice Address - Street 1:810 TALL PINE LN APT 304
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-3190
Practice Address - Country:US
Practice Address - Phone:952-239-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered