Provider Demographics
NPI:1366996209
Name:SPRINGBORN, JENNIFER (RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SPRINGBORN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 GARDEN WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5215
Mailing Address - Country:US
Mailing Address - Phone:724-981-0630
Mailing Address - Fax:724-981-7379
Practice Address - Street 1:2425 GARDEN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5215
Practice Address - Country:US
Practice Address - Phone:724-981-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered