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NPI Code Detail

MEDICARE: MRS. JENNIFER K PEDERSON RDN, LD, CDCES

MEDICARE: MRS. JENNIFER K PEDERSON RDN, LD, CDCES
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 Dietitian1269MN

General Provider Information

NPI Number : 1710929880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER K PEDERSON RDN, LD, CDCES
Provider Business Mailing Address
First Line : 111 HUNDERTMARK RD STE 115N
Second Line :
City : CHASKA
State : MN
Zip : 55318-1584
Country : US
Telephone Number : 952-361-2450
Fax Number : 952-361-2461
Provider Business Practice Location Address
First Line : 111 HUNDERTMARK RD STE 115N
Second Line :
City : CHASKA
State : MN
Zip : 55318-1584
Country : US
Telephone Number : 952-361-2450
Fax Number : 952-361-2461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 10/14/2024

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