Provider Demographics
NPI:1427437896
Name:POTTHOFF, JENNIFER (RD, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:POTTHOFF
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:D'AURORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2501 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4527
Mailing Address - Country:US
Mailing Address - Phone:814-461-6626
Mailing Address - Fax:814-871-6251
Practice Address - Street 1:2501 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:814-461-6626
Practice Address - Fax:814-871-6251
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered