Provider Demographics
NPI:1306288493
Name:RICHNER, JENALEE GFELLER
Entity type:Individual
Prefix:
First Name:JENALEE
Middle Name:GFELLER
Last Name:RICHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENALEE
Other - Middle Name:ANN
Other - Last Name:GFELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:4005 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8739
Mailing Address - Country:US
Mailing Address - Phone:330-206-0952
Mailing Address - Fax:
Practice Address - Street 1:4005 POND VIEW DR
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8739
Practice Address - Country:US
Practice Address - Phone:330-206-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004959133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN004959OtherPA LICENSE NUMBER