Individual
MISS JENNIFER NICHOLE LEASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
253 MERRIFIELD AVE, OCEANSIDE, NY 11572-2911
(516) 425-3637
Mailing address
253 MERRIFIELD AVE, OCEANSIDE, NY 11572-2911
(516) 425-3637
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86014416
NY
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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