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NPI Code Detail

MEDICARE: JENNIFER L PETERMAN RD

MEDICARE: JENNIFER L PETERMAN RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1255602371
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L PETERMAN RD
Provider Business Mailing Address
First Line : 407 S NELSON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2138
Country : US
Telephone Number : 616-754-6185
Fax Number :
Provider Business Practice Location Address
First Line : 407 S NELSON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2138
Country : US
Telephone Number : 616-754-6407
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2012
Last Update Date : 01/20/2012

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Directions to “ JENNIFER L PETERMAN RD” Practice Location

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