Provider Demographics
NPI:1427530096
Name:JASICK, DANA R (RDN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:JASICK
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 1:2373 CENTRAL PARK BLVD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2300
Mailing Address - Country:US
Mailing Address - Phone:231-750-6885
Mailing Address - Fax:
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:231-750-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86076536OtherCOMMISSION ON DIETETIC REGISTRATION