Provider Demographics
NPI:1801247986
Name:JARAMILLO, SHENA ROSE (RD, CD)
Entity type:Individual
Prefix:MS
First Name:SHENA
Middle Name:ROSE
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:KITTITAS
Mailing Address - State:WA
Mailing Address - Zip Code:98934-1146
Mailing Address - Country:US
Mailing Address - Phone:509-607-8972
Mailing Address - Fax:
Practice Address - Street 1:413 N MAIN ST
Practice Address - Street 2:SUITE J
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3183
Practice Address - Country:US
Practice Address - Phone:509-899-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI-60509103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered