Healthcare Provider Details

I. General information

NPI: 1578662664
Provider Name (Legal Business Name): JENNIFER RYAN VESPER RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 BOOMER RD TOTAL NUTRITION THERAPY LLC
CINCINNATI OH
45247
US

IV. Provider business mailing address

3809 HOPPER HILL RD
CINCINNATI OH
45255-5053
US

V. Phone/Fax

Practice location:
  • Phone: 513-477-4270
  • Fax: 859-586-7017
Mailing address:
  • Phone: 513-349-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: