Provider Demographics
NPI:1053954560
Name:HOLMAN, JENNIFER (RD, CDE)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 CALVERHALL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3254
Mailing Address - Country:US
Mailing Address - Phone:916-735-6952
Mailing Address - Fax:
Practice Address - Street 1:3100 DOUGLAS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3868
Practice Address - Country:US
Practice Address - Phone:916-774-8885
Practice Address - Fax:916-774-8818
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850539133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered