Provider Demographics
NPI:1902361496
Name:ESOO, JENNA BERNADETTE (RDN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:BERNADETTE
Last Name:ESOO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 HOLCOMB RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2617
Mailing Address - Country:US
Mailing Address - Phone:774-613-0425
Mailing Address - Fax:
Practice Address - Street 1:332 HOLCOMB RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2617
Practice Address - Country:US
Practice Address - Phone:774-613-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4205133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered