Provider Demographics
NPI:1336812049
Name:CHRISTIANSON, JENNA ROSE (RD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:CHRISTIANSON
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 1:19518 430TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:SD
Mailing Address - Zip Code:57221-5507
Mailing Address - Country:US
Mailing Address - Phone:605-690-0976
Mailing Address - Fax:
Practice Address - Street 1:19518 430TH AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:SD
Practice Address - Zip Code:57221-5507
Practice Address - Country:US
Practice Address - Phone:605-690-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
SD0775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered