Provider Demographics
NPI:1356740773
Name:TEBB, JENNIFER NEAL (RDN, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NEAL
Last Name:TEBB
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:NEALIE
Other - Middle Name:
Other - Last Name:TEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, LDN
Mailing Address - Street 1:3612 SHANNON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6333
Mailing Address - Country:US
Mailing Address - Phone:919-870-1001
Mailing Address - Fax:919-516-0673
Practice Address - Street 1:3612 SHANNON RD STE 103
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6333
Practice Address - Country:US
Practice Address - Phone:919-870-1001
Practice Address - Fax:919-516-0673
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered