Provider Demographics
NPI:1528891405
Name:MARS, JENNIFER M WEBER (RD LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M WEBER
Last Name:MARS
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SONIE DR
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8588
Mailing Address - Country:US
Mailing Address - Phone:724-272-0813
Mailing Address - Fax:
Practice Address - Street 1:208 SONIE DR
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8588
Practice Address - Country:US
Practice Address - Phone:724-272-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty