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General NPI Number Information
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NPI Number | 1700543469
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Entity Type | Individual
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Provider Name | JENNIFER MARIE ORTLEPP MS,
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 4404 E PUEBLO AVE
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City | PHOENIX
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State | AZ
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Zip | 85040-2030
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Country | US
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Telephone | 928-813-5448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24911
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City | TEMPE
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State | AZ
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Zip | 85285-4911
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Country | US
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Telephone | 859-835-3630
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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 |
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License Number State |
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