MEDICARE: MRS. JENNIFER LYNN SMITH MS RD LD LMT

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	133VN1004X	Pediatric Nutrition Registered Dietitian	5531	OH

General Provider Information

NPI Number	:	1962668392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN SMITH MS RD LD LMT

Provider Business Mailing Address
First Line	:	59 W DAVE LONGABERGER AVE
Second Line	:
City	:	DRESDEN
State	:	OH
Zip	:	43821-9687
Country	:	US
Telephone Number	:	740-252-8034
Fax Number	:	614-722-3098

Provider Business Practice Location Address
First Line	:	59 W DAVE LONGABERGER AVE
Second Line	:
City	:	DRESDEN
State	:	OH
Zip	:	43821-9687
Country	:	US
Telephone Number	:	740-252-8034
Fax Number	:	614-722-3098

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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