Provider Demographics
NPI:1770097826
Name:CHRISTENSEN, JOLENE (RD, LD)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:O'GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5745
Mailing Address - Country:US
Mailing Address - Phone:515-956-2972
Mailing Address - Fax:
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5745
Practice Address - Country:US
Practice Address - Phone:515-956-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered