Healthcare Provider Details

I. General information

NPI: 1457035966
Provider Name (Legal Business Name): JENNA YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 KING OF PRUSSIA RD
RADNOR PA
19087-4440
US

IV. Provider business mailing address

320 KING OF PRUSSIA RD
RADNOR PA
19087-4440
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: