Provider Demographics
NPI:1982947412
Name:GUIN, JENNIFER (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUIN
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 FAIRFIELD AVE ROOM 569
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-676-7489
Mailing Address - Fax:318-676-7560
Practice Address - Street 1:1525 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-676-7489
Practice Address - Fax:318-676-7560
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered