Provider Demographics
NPI:1659860880
Name:JILLIAN M GREAVES
Entity Type:Organization
Organization Name:JILLIAN M GREAVES
Other - Org Name:PREVENTION PANTRY NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:617-803-0808
Mailing Address - Street 1:665 BOYLSTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4825
Mailing Address - Country:US
Mailing Address - Phone:857-244-0162
Mailing Address - Fax:617-507-6172
Practice Address - Street 1:665 BOYLSTON ST STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4825
Practice Address - Country:US
Practice Address - Phone:857-244-0162
Practice Address - Fax:617-507-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty