Provider Demographics
NPI:1104680321
Name:JONES, NADINE JANE (RD)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:JANE
Last Name:JONES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:NADINE
Other - Middle Name:JANE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5846 CANAL BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8053
Mailing Address - Country:US
Mailing Address - Phone:989-390-3463
Mailing Address - Fax:
Practice Address - Street 1:5846 CANAL BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8053
Practice Address - Country:US
Practice Address - Phone:989-390-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10436133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered