Provider Demographics
NPI:1497221220
Name:TERRACCIANO, JILL DANIELLE (RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DANIELLE
Last Name:TERRACCIANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:DANIELLE
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:102 E ELM AVENUE
Mailing Address - Street 2:
Mailing Address - City:COEUR D' ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-819-8413
Mailing Address - Fax:
Practice Address - Street 1:102 E ELM AVENUE
Practice Address - Street 2:
Practice Address - City:COEUR D' ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-819-8413
Practice Address - Fax:208-485-4781
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86026768133V00000X
WA60641059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered