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General NPI Number Information
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NPI Number | 1750003554
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Entity Type | Individual
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Provider Name | JENNA MARIE MCCALLUM
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 122 E LAS ANIMAS ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-4138
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Country | US
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Telephone | 719-551-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 N EL PASO ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7737
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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 |
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License Number State |
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