Provider Demographics
NPI:1205084977
Name:WALTNER, JESSICA R (RD, LN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:WALTNER
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:GASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5647
Mailing Address - Country:US
Mailing Address - Phone:605-334-7231
Mailing Address - Fax:
Practice Address - Street 1:3000 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5647
Practice Address - Country:US
Practice Address - Phone:605-334-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered