Provider Demographics
NPI:1356385751
Name:PAS, JENNIFER M (RD, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PAS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4425 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2681
Mailing Address - Country:US
Mailing Address - Phone:505-332-8070
Mailing Address - Fax:
Practice Address - Street 1:4425 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2681
Practice Address - Country:US
Practice Address - Phone:505-332-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM362133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
344235303Medicare ID - Type Unspecified