Provider Demographics
NPI:1861061707
Name:MENNETTI, JANNA LYN (RD LD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:LYN
Last Name:MENNETTI
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:LYN
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:612 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1613
Mailing Address - Country:US
Mailing Address - Phone:419-388-8596
Mailing Address - Fax:
Practice Address - Street 1:612 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1613
Practice Address - Country:US
Practice Address - Phone:419-388-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4490133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered