Provider Demographics
NPI:1427774199
Name:JENN T RD, LLC
Entity type:Organization
Organization Name:JENN T RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:THIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LMNT
Authorized Official - Phone:402-303-3134
Mailing Address - Street 1:7632 N 153RD CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1553
Mailing Address - Country:US
Mailing Address - Phone:402-218-8363
Mailing Address - Fax:
Practice Address - Street 1:7632 N 153RD CIR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1553
Practice Address - Country:US
Practice Address - Phone:402-303-3134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty