Healthcare Provider Details

I. General information

NPI: 1093902629
Provider Name (Legal Business Name): JENNIFER ELLET RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number999
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: