Provider Demographics
NPI:1972966026
Name:JATZKE, ALEXANDRA BRADY (RD)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:BRADY
Last Name:JATZKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ASH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6315
Mailing Address - Country:US
Mailing Address - Phone:856-443-3995
Mailing Address - Fax:
Practice Address - Street 1:2 PENN CTR STE 450
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1733
Practice Address - Country:US
Practice Address - Phone:484-450-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1091142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered