Healthcare Provider Details

I. General information

NPI: 1831000652
Provider Name (Legal Business Name): JILLEON ROY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLEON FARRELL RD

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAIN ST
MONMOUTH ME
04259-7029
US

IV. Provider business mailing address

PO BOX 101
MONMOUTH ME
04259-0101
US

V. Phone/Fax

Practice location:
  • Phone: 207-500-3148
  • Fax:
Mailing address:
  • Phone: 207-500-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI2149
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: