Individual
JESSICA PROHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CSR, LDN
Contact information
Practice address
35 HINGHAM RD, NORTH GRAFTON, MA 01536-1281
(508) 685-0624
Mailing address
35 HINGHAM RD, NORTH GRAFTON, MA 01536-1281
Taxonomy
Speciality
Code
Description
License number
State
133VN1005X
Renal Nutrition Registered Dietitian
Primary
2870
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2870
DIETITIAN/NUTRITIONIST STATE LICENSE
MA
Enumeration date
03/29/2020
Last updated
03/29/2020
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