Healthcare Provider Details

I. General information

NPI: 1285361964
Provider Name (Legal Business Name): JENNIFER LYNN VACHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 BROWNSON RD
ANNAPOLIS MD
21402-5006
US

IV. Provider business mailing address

608 ADMIRAL DR APT 440
ANNAPOLIS MD
21401-7540
US

V. Phone/Fax

Practice location:
  • Phone: 508-728-8256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: