NPI 1295138584 · live from the CMS NPI Registry
Jessica Averill, RD
Dietitian, Registered in Wyoming, MI. National Provider Identifier 1295138584, active.
NPI record
| NPI | 1295138584 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 2215 44th St Sw, Wyoming, MI 49519 |
| Practice phone | 616-252-8339 |
| Mailing address | 2687 Hillandale Dr Nw, Walker, MI 49534 |
| Enumerated | October 1, 2014 |
| Last updated | October 1, 2014 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 944934 (MI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.