Provider Demographics
NPI:1932896164
Name:CALCATERRA, JENNA L (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:CALCATERRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 GRAY HERON DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1946
Mailing Address - Country:US
Mailing Address - Phone:970-215-5915
Mailing Address - Fax:
Practice Address - Street 1:7196 GRAY HERON DR
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-1946
Practice Address - Country:US
Practice Address - Phone:970-215-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4276133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered