Provider Demographics
NPI:1740679109
Name:BAIN, JENNIFER (MED, RDN, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:MED, RDN, LDN
Other - Prefix:PROF
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, RDN, LDN
Mailing Address - Street 1:11986 BARNESWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1301
Mailing Address - Country:US
Mailing Address - Phone:513-445-9881
Mailing Address - Fax:
Practice Address - Street 1:11986 BARNESWOOD CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1301
Practice Address - Country:US
Practice Address - Phone:513-445-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD7368133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered