Provider Demographics
NPI:1366279408
Name:VITRY, JENNIFER (DCN(C), MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VITRY
Suffix:
Gender:F
Credentials:DCN(C), MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8922 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1406
Mailing Address - Country:US
Mailing Address - Phone:504-905-8663
Mailing Address - Fax:504-555-0212
Practice Address - Street 1:248 S DORGENOIS ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6424
Practice Address - Country:US
Practice Address - Phone:504-905-8663
Practice Address - Fax:504-555-0212
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6027133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist