Provider Demographics
NPI:1598266843
Name:ATWOOD, JILL (RD)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:480 MAPLE STREET- LIFESTYLE MANAGEMENT INSTITUTE
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1923
Mailing Address - Country:US
Mailing Address - Phone:978-304-8401
Mailing Address - Fax:987-304-8447
Practice Address - Street 1:480 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1923
Practice Address - Country:US
Practice Address - Phone:978-304-8401
Practice Address - Fax:987-304-8447
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3011133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered