Provider Demographics
NPI:1023908845
Name:GRESETH, JILL (RDN, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GRESETH
Suffix:
Gender:F
Credentials:RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1623
Mailing Address - Country:US
Mailing Address - Phone:763-228-4339
Mailing Address - Fax:
Practice Address - Street 1:214 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-1623
Practice Address - Country:US
Practice Address - Phone:763-228-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered