Provider Demographics
NPI:1255617940
Name:MURPHY, JENNA LAREE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LAREE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LAREE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:321 E HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1629
Mailing Address - Country:US
Mailing Address - Phone:517-543-1050
Mailing Address - Fax:517-541-5972
Practice Address - Street 1:321 E HARRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1629
Practice Address - Country:US
Practice Address - Phone:517-543-1050
Practice Address - Fax:517-541-5972
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered