Provider Demographics
NPI:1649052192
Name:NEVEN, JAMIE (RD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:NEVEN
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 1:7551 BAUX MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTON
Mailing Address - State:NC
Mailing Address - Zip Code:27019-9494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7551 BAUX MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GERMANTON
Practice Address - State:NC
Practice Address - Zip Code:27019-9494
Practice Address - Country:US
Practice Address - Phone:815-953-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002994A133V00000X
NCL007009133V00000X
IL164007447133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered