MEDICARE: JENNIFER OSANTOWSKI RDN

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
1	133V00000X	Registered Dietitian	959284	MI

General Provider Information

NPI Number	:	1821612540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER OSANTOWSKI RDN

Provider Business Mailing Address
First Line	:	1651 HELEN DR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 HAKES DR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5574
Country	:	US
Telephone Number	:	269-350-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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Directions to “ JENNIFER OSANTOWSKI RDN” Practice Location

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