Provider Demographics
NPI:1104976042
Name:HAHN, JENNIE MARIE (RD)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:MARIE
Last Name:HAHN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1703 ARBORVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3651
Mailing Address - Country:US
Mailing Address - Phone:734-665-1506
Mailing Address - Fax:
Practice Address - Street 1:5320 ELLIOTT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1032
Practice Address - Country:US
Practice Address - Phone:734-712-1047
Practice Address - Fax:734-712-1391
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI#OP 16870001Medicare UPIN