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Samantha Jackson, RD

Dietitian, Registered in Eau Claire, WI. Individual provider (NPI-1).

NPI number1609548544
StatusActive
Last updated in NPPESOct 21, 2021

Details

NPI
1609548544
Entity type
Individual (NPI-1)
Name
Samantha Jackson
Credential
RD
Sex
Female
Sole proprietor
No
Enumeration date
Sep 29, 2021
Certification date
Oct 21, 2021
Last updated
Oct 21, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered3178-29WIYes

Practice location

1400 Bellinger St
Eau Claire, WI 54703-5222

Phone 715-838-5222

Mailing address

200 1st St Sw
Rochester, MN 55905-0001

Phone 715-838-5222

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