Provider Demographics
NPI:1942223656
Name:YOUNG, JILL A (MNT,RD)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MNT,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREAT FALLS PLZ
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5966
Mailing Address - Country:US
Mailing Address - Phone:207-783-0933
Mailing Address - Fax:207-783-0933
Practice Address - Street 1:2 GREAT FALLS PLZ
Practice Address - Street 2:6TH FLOOR
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5966
Practice Address - Country:US
Practice Address - Phone:207-783-0933
Practice Address - Fax:207-783-0933
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2209976OtherAETNA
ME0890195OtherCIGNA/SCRANTON
MEMNT751OtherHARVARD PILGRIM
ME024781OtherBC/BS STAR
ME2209976OtherAETNA