Provider Demographics
NPI:1245378926
Name:MERRITT, JEANNA (RD)
Entity type:Individual
Prefix:MRS
First Name:JEANNA
Middle Name:
Last Name:MERRITT
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 1:615 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1712
Mailing Address - Country:US
Mailing Address - Phone:307-754-8231
Mailing Address - Fax:
Practice Address - Street 1:615 AVENUE K
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-1712
Practice Address - Country:US
Practice Address - Phone:307-754-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered