Provider Demographics
NPI:1790392009
Name:GRIMINGER, JILLIAN (RDN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GRIMINGER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CRESCENT DR FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1016
Mailing Address - Country:US
Mailing Address - Phone:914-629-6037
Mailing Address - Fax:
Practice Address - Street 1:3 CRESCENT DR FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:914-629-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
86110117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered