Individual
MRS. JENNIFER FILLENWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-6122
Mailing address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 685-6122
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86011107
MI
Other
Enumeration date
11/12/2014
Last updated
11/12/2014
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