Tracie Lee Jackson RD, LMNT, CDE

NPI 1982807715 - Dietitian, Registered - 133V00000X

NPI Details
NPI 1982807715
Gender Female
Enumeration Date 06/08/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
8601 W DODGE RD
SUITE # 30
OMAHA NE, 68114-3457, US
Phone (402) 354-8797
Fax (402) 354-5651
Business Location
PO BOX 127
HERMAN NE, 68029-0127, US
Phone (402) 456-7876
Fax
Toxanomy
Taxonomy Code 133V00000X
License State Nebraska
License Number 347
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According to our database, Tracie Lee Jackson RD, LMNT, CDE NPI is 1982807715, taxonomy code is 133V00000X and license number is 347, license state is located at Nebraska. Tracie Lee Jackson RD, LMNT, CDE physically located at 8601 W Dodge Rd, Omaha NE, 68114-3457. NPI Number Tracie Lee Jackson RD, LMNT, CDE has the Individual type.

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1982807715 NPI number is provided on an as is basis without warranty of any kind. 1982807715 is maintained by the National Plan & Provider Enumeration System. The contents of Tracie Lee Jackson RD, LMNT, CDE are for informational purposes only.