Provider Demographics
NPI:1063608016
Name:JENNINGS, CAROLYN ANN (MPH, RD, CDE)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-4880
Mailing Address - Fax:248-475-4881
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-4880
Practice Address - Fax:248-475-4881
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered