Healthcare Provider Details

I. General information

NPI: 1265360085
Provider Name (Legal Business Name): JENNIFER MCGOWAN MPH, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY MCGOWAN MPH, RD, LD

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 8TH ST SE UNIT 406
MINNEAPOLIS MN
55414-1183
US

IV. Provider business mailing address

6848 ARTHUR HILLS DR
WILLIAMSBURG VA
23188-7258
US

V. Phone/Fax

Practice location:
  • Phone: 770-366-5102
  • Fax:
Mailing address:
  • Phone: 770-366-5102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number5813
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: