Provider Demographics
NPI:1699599175
Name:FROMM, JASMINE IRENE (RDN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:IRENE
Last Name:FROMM
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 1:1725 BROWN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-4356
Mailing Address - Country:US
Mailing Address - Phone:423-715-7448
Mailing Address - Fax:
Practice Address - Street 1:1725 BROWN AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4356
Practice Address - Country:US
Practice Address - Phone:423-715-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4758133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered