Active NPI
Jennifer Lynn Super, RD LD
- Registered Dietitian
- Minneapolis, MN
National Provider Identifier
1841212875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2202
- Practice address
- 2450 Riverside Ave
Minneapolis, MN 55454-1450 - Phone
- (612) 273-1861
- NPI assigned
- Jul 25, 2006
- Last updated
- Nov 6, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2202 | MN | Primary |
Addresses
Primary practice location
2450 Riverside Ave
Minneapolis, MN 55454-1450
Mailing address
4388 Galtier St
Shoreview, MN 55126-2105
Phone (612) 273-1861
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2202 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415232000000",
"number": "1841212875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4388 GALTIER ST",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551262105",
"telephone_number": "612-273-1861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-273-1861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPER",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"credential": "RD LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2014-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
- Sunshine Foundation LLC
- Sunshine Health Services LLC
- Sunu Linden Hills PLLC (SuNu Wellness Center)
- Catalina Sunwoo, NP
- Savy Suos, RN, BSN
- Supervalu Pharmacies Inc (Cub Pharmacy)
- Supervalu Pharmacies Inc (Cub Pharmacy)
- Supervalu Pharmacies Inc (Cub Pharmacy)
- Supervalu Pharmacies Inc (Cub Pharmacy)
- Supervalu Pharmacies Inc (Cub Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.