Healthcare Provider Details

I. General information

NPI: 1346508223
Provider Name (Legal Business Name): JENNA BRANSKI PARZYCH R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 THURMAN AVE
COLUMBUS OH
43206-3580
US

IV. Provider business mailing address

262 THURMAN AVE
COLUMBUS OH
43206-3580
US

V. Phone/Fax

Practice location:
  • Phone: 419-307-9116
  • Fax:
Mailing address:
  • Phone: 419-307-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005614
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: