Provider Demographics
NPI:1952128415
Name:STAMP, JANESE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JANESE
Middle Name:
Last Name:STAMP
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-5319
Mailing Address - Country:US
Mailing Address - Phone:908-619-2688
Mailing Address - Fax:
Practice Address - Street 1:3135 W 42ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-5319
Practice Address - Country:US
Practice Address - Phone:908-619-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered