Individual
JENNIFER LAURA SIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
12647 OLIVE BLVD, SUITE 600, SAINT LOUIS, MO 63141-6345
(800) 325-3982
Mailing address
7828 PAT BOOKER RD, APT. 712, LIVE OAK, TX 78233-2618
(806) 441-2320
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT06855
TX
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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