Provider Demographics
NPI:1205516614
Name:WASMUTH, JAN (RDN)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:WASMUTH
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 1:1837 CAROL LYNN DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-3279
Mailing Address - Country:US
Mailing Address - Phone:765-513-9307
Mailing Address - Fax:
Practice Address - Street 1:1837 CAROL LYNN DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-3279
Practice Address - Country:US
Practice Address - Phone:765-513-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered