Provider Demographics
NPI:1386325033
Name:MAIER, JENNIFER (RDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAIER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 NW 191ST ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2736
Mailing Address - Country:US
Mailing Address - Phone:206-678-3596
Mailing Address - Fax:
Practice Address - Street 1:1258 NW 191ST ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2736
Practice Address - Country:US
Practice Address - Phone:206-678-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60400754133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered