Provider Demographics
NPI:1104235100
Name:DEMOSS, JENA (RD, LD)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:DEMOSS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:PAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7180 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1122
Mailing Address - Country:US
Mailing Address - Phone:507-437-7625
Mailing Address - Fax:
Practice Address - Street 1:1001 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1890
Practice Address - Country:US
Practice Address - Phone:507-437-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered