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General NPI Number Information
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NPI Number | 1881832616
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Entity Type | Individual
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Provider Name | BRYN E JAFRI L.N., ACSM-HFS
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Gender | Male
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 11121 MANTEO CT
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City | FORTVILLE
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State | IN
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Zip | 46040-9135
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Country | US
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Telephone | 571-251-7635
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Fax |
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Provider Business Mailing Address
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Address Line | 11121 MANTEO CT
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City | FORTVILLE
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State | IN
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Zip | 46040-9135
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Country | US
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Telephone | 571-251-7635
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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 | NU100000130
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License Number State | DC
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