Most Relevant Information
Provider Data
| NPI Number: | 1003531815 |
| Provider Name: | JENNA WIDMAN |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 86113322 |
Most Important Dates
| Enumeration Date: | 10/05/2022 |
| Last Updated: | 10/05/2022 |
Provider Practice Location
1551 PROSPECT AVE
ROCKY RIVER
OH
441161932
Practice Location Phone/Fax
| Phone: | 7192322087 |
| Fax: |
Provider Mailing Location
1551 PROSPECT AVE
ROCKY RIVER
OH
441161932
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |