Provider Demographics
NPI:1174852115
Name:KOEGEL, JILL R (RD, LMNT, CSSD, CDE)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:KOEGEL
Suffix:
Gender:F
Credentials:RD, LMNT, CSSD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 S 187TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6102
Mailing Address - Country:US
Mailing Address - Phone:402-350-8664
Mailing Address - Fax:
Practice Address - Street 1:17940 WELCH PLZ STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3714
Practice Address - Country:US
Practice Address - Phone:402-350-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered