Provider Demographics
NPI:1518044767
Name:JARECKE-PAULSEN, JILL N (MS RD LMNT CDE)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:JARECKE-PAULSEN
Suffix:
Gender:F
Credentials:MS RD LMNT CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 W FAIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4205
Mailing Address - Country:US
Mailing Address - Phone:308-398-5862
Mailing Address - Fax:308-398-6565
Practice Address - Street 1:2620 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4205
Practice Address - Country:US
Practice Address - Phone:308-398-5862
Practice Address - Fax:308-398-6565
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE560133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275235Medicare ID - Type UnspecifiedLMNT