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Organization
LIFESTYLE NUTRITION
Active
Organization
LIFESTYLE NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JACLYN A JACOBSEN M.S. (NUTRITIONIST/OWNER)
(845) 379-4616
Entity
Organization
Contact information
Practice address
42 OAK ST, LINCOLN PARK, NJ 07035-2434
(845) 379-4616
Mailing address
42 OAK ST, LINCOLN PARK, NJ 07035-2434
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
NULL
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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