IndividualActive
Colleen Jackson
NPI 1669629275 · Nutrition Education Nutritionist · Patchogue, NY
Provider details
- NPI number
- 1669629275
- Entity type
- Individual
- Primary specialty
- Nutrition Education NutritionistDietary & Nutritional Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 004661 (NY)
Specialties & taxonomies
Dietary & Nutritional Service Providers
Practice location
101 Hospital Rd
Patchogue, NY 11772-4870
Phone: (631) 654-7236
Approximate (ZIP-level) locationGet directions
Mailing address
101 Hospital Rd
Patchogue, NY 11772-4870
Registry dates
- Enumerated
- 2008-08-26
- Last updated
- 2008-08-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.