Provider Demographics
NPI:1770738445
Name:KWASNY, JILL WENDY (MS RD CDE)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:WENDY
Last Name:KWASNY
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:WENDY
Other - Last Name:KWASNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS RD CDE
Mailing Address - Street 1:1039 S KIMBLES RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2635
Mailing Address - Country:US
Mailing Address - Phone:215-321-9737
Mailing Address - Fax:215-321-7393
Practice Address - Street 1:1039 S KIMBLES RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-2635
Practice Address - Country:US
Practice Address - Phone:215-321-9737
Practice Address - Fax:215-321-7393
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered