Provider Demographics
NPI:1205336179
Name:MARONDE, JILL (MS NUTRITION)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MARONDE
Suffix:
Gender:F
Credentials:MS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17730 SW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7154
Mailing Address - Country:US
Mailing Address - Phone:503-691-2800
Mailing Address - Fax:
Practice Address - Street 1:15895 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7977
Practice Address - Country:US
Practice Address - Phone:503-430-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist