Provider Demographics
NPI:1245110022
Name:BLATTNER, JAKE F (MS, RD, CSSD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:F
Last Name:BLATTNER
Suffix:
Gender:M
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7858 CREEK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3843
Mailing Address - Country:US
Mailing Address - Phone:507-696-5935
Mailing Address - Fax:
Practice Address - Street 1:800 STADIUM DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0030
Practice Address - Country:US
Practice Address - Phone:507-696-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics