Provider Demographics
NPI:1881493229
Name:ENDTER, JEENA DAWN (RDN, MS)
Entity type:Individual
Prefix:
First Name:JEENA
Middle Name:DAWN
Last Name:ENDTER
Suffix:
Gender:
Credentials:RDN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13074 SW VALLETTA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-5472
Mailing Address - Country:US
Mailing Address - Phone:239-564-1998
Mailing Address - Fax:
Practice Address - Street 1:13074 SW VALLETTA WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-5472
Practice Address - Country:US
Practice Address - Phone:239-564-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86294787133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered