Provider Demographics
NPI:1750081782
Name:KRUZAN, JESSICA RAE (RDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:KRUZAN
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 1:1703 N TALMAN AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-9653
Mailing Address - Country:US
Mailing Address - Phone:630-485-1913
Mailing Address - Fax:
Practice Address - Street 1:160 N WACKER DR UNIT 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1633
Practice Address - Country:US
Practice Address - Phone:312-374-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered