Provider Demographics
NPI:1942024872
Name:SMITH, CHRISTINA JO (MS, RD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JO
Other - Last Name:MACKAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934-2177
Mailing Address - Country:US
Mailing Address - Phone:609-204-9804
Mailing Address - Fax:
Practice Address - Street 1:3 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934-2177
Practice Address - Country:US
Practice Address - Phone:609-204-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1060347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered