Provider Demographics
NPI:1447004320
Name:PETRUCCI DRANE, JENNIFER EILEEN (RD, LD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EILEEN
Last Name:PETRUCCI DRANE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:DRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:6951 151ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4554
Mailing Address - Country:US
Mailing Address - Phone:612-719-9391
Mailing Address - Fax:
Practice Address - Street 1:1451 ADAMS ST S
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2697
Practice Address - Country:US
Practice Address - Phone:952-403-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered