Provider Demographics
NPI:1487323515
Name:SMITH, JORDAN ANNE (RD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3126
Mailing Address - Country:US
Mailing Address - Phone:585-490-2628
Mailing Address - Fax:
Practice Address - Street 1:121 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-3126
Practice Address - Country:US
Practice Address - Phone:585-490-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered