Provider Demographics
NPI:1750093902
Name:MENGEL, JEANNINE Y (RD)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:Y
Last Name:MENGEL
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 1:611 D ST APT C
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5539
Mailing Address - Country:US
Mailing Address - Phone:916-798-6514
Mailing Address - Fax:
Practice Address - Street 1:611 D ST APT C
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5539
Practice Address - Country:US
Practice Address - Phone:916-798-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86091305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered