Provider Demographics
NPI:1174703466
Name:DRANGE, JODY LYNN (RD, CDE, ACSM EP-C)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:DRANGE
Suffix:
Gender:F
Credentials:RD, CDE, ACSM EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 ETHAN ALLEN HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9569
Mailing Address - Country:US
Mailing Address - Phone:802-881-2936
Mailing Address - Fax:
Practice Address - Street 1:459 N GILBERT RD STE C110
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4755
Practice Address - Country:US
Practice Address - Phone:480-393-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ305089Medicaid
AZ305089Medicaid