Provider Demographics
NPI:1699729764
Name:GRENNELL, JACQUELINE DEVNO (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DEVNO
Last Name:GRENNELL
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 1:64R GUNNERS EXCHANGE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3124
Mailing Address - Country:US
Mailing Address - Phone:508-746-9030
Mailing Address - Fax:508-746-9030
Practice Address - Street 1:64R GUNNERS EXCHANGE RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3124
Practice Address - Country:US
Practice Address - Phone:508-746-9030
Practice Address - Fax:508-746-9030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA395133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered