Provider Demographics
NPI:1396149936
Name:MACON, JANET (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MACON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 INTEGRATED WELLNESS COMPLEX
Mailing Address - Street 2:P.O. BOX 5838
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5838
Mailing Address - Country:US
Mailing Address - Phone:507-457-5160
Mailing Address - Fax:
Practice Address - Street 1:22 INTEGRATED WELLNESS COMPLEX
Practice Address - Street 2:175 WEST MARK STREET
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5838
Practice Address - Country:US
Practice Address - Phone:507-457-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered