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General NPI Number Information
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NPI Number | 1619668472
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Entity Type | Individual
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Provider Name | JENNIFER MCDOW MS, CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1202 KELLS CT
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City | LAKELAND
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State | FL
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Zip | 33813-1243
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Country | US
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Telephone | 352-665-6639
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 KELLS CT
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City | LAKELAND
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State | FL
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Zip | 33813-1243
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 12100
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License Number State | FL
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