Provider Demographics
NPI:1750587556
Name:CHURCO, JILL MARIE (RD LDN)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:CHURCO
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CAMP JAHN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9568
Mailing Address - Country:US
Mailing Address - Phone:860-748-1237
Mailing Address - Fax:413-582-2933
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:NUTRITION DEPARTMENT
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2325
Practice Address - Fax:413-582-2933
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered