Provider Demographics
NPI:1215690797
Name:KRAFFT, JENNIFER ANN (RDN CDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:KRAFFT
Suffix:
Gender:F
Credentials:RDN CDN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:4019 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2821
Mailing Address - Country:US
Mailing Address - Phone:315-391-4596
Mailing Address - Fax:
Practice Address - Street 1:7 ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1313
Practice Address - Country:US
Practice Address - Phone:315-730-4459
Practice Address - Fax:315-685-2150
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001571133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered