Provider Demographics
NPI:1427103183
Name:MYERS, JANE (LIC REG DIETITAN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:LIC REG DIETITAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237
Mailing Address - Country:US
Mailing Address - Phone:701-352-1620
Mailing Address - Fax:701-352-1671
Practice Address - Street 1:164 W 13TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237
Practice Address - Country:US
Practice Address - Phone:701-352-1620
Practice Address - Fax:701-352-1671
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12794OtherBCBS ND
ND012794Medicaid
ND12794OtherBCBS ND