Healthcare Provider Details

I. General information

NPI: 1619074945
Provider Name (Legal Business Name): JILL KAY MACFARLANE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 NORTH 40TH STREET BLDG 5 STE 135
PHOENIX AZ
85032-0000
US

IV. Provider business mailing address

3003 N CENTRAL AVENUE, STE 400 AKDHC, LLC
PHOENIX AZ
85012-0000
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: