Provider Demographics
NPI:1386413029
Name:FERRUZZI, JENICA (MS RDN)
Entity type:Individual
Prefix:
First Name:JENICA
Middle Name:
Last Name:FERRUZZI
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4548
Mailing Address - Country:US
Mailing Address - Phone:717-723-1974
Mailing Address - Fax:
Practice Address - Street 1:825 DELAWARE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6169
Practice Address - Country:US
Practice Address - Phone:717-723-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86068836133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered