Provider Demographics
NPI:1255109054
Name:NIELSEN, JILLIAN (RD, CSP, LD, CNSC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RD, CSP, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3009
Mailing Address - Country:US
Mailing Address - Phone:207-358-9887
Mailing Address - Fax:844-903-4677
Practice Address - Street 1:322 ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3009
Practice Address - Country:US
Practice Address - Phone:207-358-9887
Practice Address - Fax:844-903-4677
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1637133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered