Healthcare Provider Details

I. General information

NPI: 1508697061
Provider Name (Legal Business Name): HANNAH JUNGKEIT CNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5236 F ST
SACRAMENTO CA
95819-3201
US

IV. Provider business mailing address

5236 F ST
SACRAMENTO CA
95819-3201
US

V. Phone/Fax

Practice location:
  • Phone: 916-842-8118
  • Fax:
Mailing address:
  • Phone: 916-842-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: