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General NPI Number Information
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NPI Number | 1053131490
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Entity Type | Organization
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Legal Business Name | JENNIFER TRIASSI LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 24 OAKWOOD DR
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City | MILLVILLE
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State | PA
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Zip | 17846
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Country | US
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Telephone | 570-764-3522
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 SCOTT TOWN CTR # 1027
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City | BLOOMSBURG
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State | PA
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Zip | 17815-2356
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Country | US
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Telephone | 570-764-3522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER TRIASSI
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Credential | RD
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Telephone | 570-764-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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