Provider Demographics
NPI:1881249415
Name:HEARTCASTLE, JENNIFER (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HEARTCASTLE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HODSDON RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:ME
Mailing Address - Zip Code:04069-6402
Mailing Address - Country:US
Mailing Address - Phone:207-317-6726
Mailing Address - Fax:
Practice Address - Street 1:367 US-1
Practice Address - Street 2:SOUTH BUILDING
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105
Practice Address - Country:US
Practice Address - Phone:207-317-6726
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered