Provider Demographics
NPI:1972363182
Name:DIETITIAN JESS NUTRITION
Entity type:Organization
Organization Name:DIETITIAN JESS NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGORE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:412-860-7627
Mailing Address - Street 1:213 HOLLY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2361
Mailing Address - Country:US
Mailing Address - Phone:412-860-7627
Mailing Address - Fax:412-202-1974
Practice Address - Street 1:213 HOLLY RIDGE DR
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-2361
Practice Address - Country:US
Practice Address - Phone:412-860-7627
Practice Address - Fax:412-202-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty