Provider Demographics
NPI:1538853650
Name:MUSSALLEM, JENIE MARYLYNN (MS, CNS)
Entity type:Individual
Prefix:MRS
First Name:JENIE
Middle Name:MARYLYNN
Last Name:MUSSALLEM
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:MISS
Other - First Name:JENIE
Other - Middle Name:MARYLYNN
Other - Last Name:LIBERATORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4910
Mailing Address - Country:US
Mailing Address - Phone:267-565-7915
Mailing Address - Fax:
Practice Address - Street 1:145 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-4910
Practice Address - Country:US
Practice Address - Phone:267-565-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist