Healthcare Provider Details

I. General information

NPI: 1952136228
Provider Name (Legal Business Name): JENN PITMAN NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PINE ST
MANCHESTER BY THE SEA MA
01944-1021
US

IV. Provider business mailing address

100 PINE ST
MANCHESTER BY THE SEA MA
01944-1021
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-1925
  • Fax:
Mailing address:
  • Phone: 310-663-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER L SEELEY
Title or Position: NUTRITIONIST
Credential: MS. CNS.
Phone: 310-663-1925