Healthcare Provider Details

I. General information

NPI: 1821348962
Provider Name (Legal Business Name): JEANNA M HAGGARD MFCS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S MAIN ST
FINDLAY OH
45840-1214
US

IV. Provider business mailing address

1900 S MAIN ST
FINDLAY OH
45840-1214
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-4500
  • Fax:
Mailing address:
  • Phone: 419-423-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLD.4670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: