Provider Demographics
NPI:1255670352
Name:HEIMILLER, JILLIAN O (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:O
Last Name:HEIMILLER
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:K
Other - Last Name:OUHRABKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 RED CHIMNEY DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-9522
Mailing Address - Country:US
Mailing Address - Phone:401-529-7925
Mailing Address - Fax:
Practice Address - Street 1:434 RED CHIMNEY DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-9522
Practice Address - Country:US
Practice Address - Phone:401-529-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00739133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered