Provider Demographics
NPI:1104325497
Name:REMCNAMARA, JEANNINE MARIE (RD)
Entity type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:MARIE
Last Name:REMCNAMARA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-2015
Mailing Address - Country:US
Mailing Address - Phone:732-713-6667
Mailing Address - Fax:
Practice Address - Street 1:40 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-2015
Practice Address - Country:US
Practice Address - Phone:732-713-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
817146133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
817146OtherCOMMISSION ON DIETETIC REGISTRATION