Healthcare Provider Details

I. General information

NPI: 1932316239
Provider Name (Legal Business Name): JILL GIESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7394 FAWN HILL DR
HORNELL NY
14843-9153
US

IV. Provider business mailing address

7394 FAWN HILL DR
HORNELL NY
14843-9153
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-0741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number004336-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: