Provider Demographics
NPI:1881496016
Name:EAGLE, JESSICA ANNA (RD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNA
Last Name:EAGLE
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6623
Mailing Address - Country:US
Mailing Address - Phone:650-400-6586
Mailing Address - Fax:
Practice Address - Street 1:914 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6623
Practice Address - Country:US
Practice Address - Phone:650-400-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86344455133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered