Provider Demographics
NPI:1902652688
Name:VAN DALEN, JESSICA (RD, LD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VAN DALEN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7180
Mailing Address - Country:US
Mailing Address - Phone:563-663-5920
Mailing Address - Fax:
Practice Address - Street 1:228 W PARK AVE
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-7180
Practice Address - Country:US
Practice Address - Phone:563-663-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered