Provider Demographics
NPI:1740962901
Name:LARESE, JAIME JENNIFER (RDN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:JENNIFER
Last Name:LARESE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 N LAMBORN ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3126
Mailing Address - Country:US
Mailing Address - Phone:406-431-5891
Mailing Address - Fax:
Practice Address - Street 1:1208 N LAMBORN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3126
Practice Address - Country:US
Practice Address - Phone:406-431-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1004212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered