Individual
MRS. JENNIFER LIND WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., C.D.E.
Contact information
Practice address
5300 S. HIGHWAY 95 STE A, FORT MOHAVE, AZ 86426
(928) 768-9496
Mailing address
P.0. BOX 9479, FORT MOHAVE, AZ 86426
(928) 768-9496
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
817192
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0258900
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
09/14/2006
Last updated
07/21/2022
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