Provider Demographics
NPI:1750966586
Name:SEFCIK, JENNIFER BLAINE (RDN,LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BLAINE
Last Name:SEFCIK
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:BLAINE
Other - Last Name:SEFCIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN,LDN
Mailing Address - Street 1:3448 TEAL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2698
Mailing Address - Country:US
Mailing Address - Phone:865-406-4913
Mailing Address - Fax:
Practice Address - Street 1:3448 TEAL CREEK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2698
Practice Address - Country:US
Practice Address - Phone:865-406-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered