Provider Demographics
NPI:1538448303
Name:JANSON, MERICA R (RD)
Entity type:Individual
Prefix:
First Name:MERICA
Middle Name:R
Last Name:JANSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MERICA
Other - Middle Name:
Other - Last Name:REDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 35229
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0229
Mailing Address - Country:US
Mailing Address - Phone:804-592-4751
Mailing Address - Fax:804-592-4752
Practice Address - Street 1:8014 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200-A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-592-4751
Practice Address - Fax:804-592-4752
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1016119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered