Healthcare Provider Details

I. General information

NPI: 1457570434
Provider Name (Legal Business Name): JILL LAUREN GUISEPPE R.D., L.D.N., C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 N FRONT ST
PHILADELPHIA PA
19140-4642
US

IV. Provider business mailing address

3635 N FRONT ST
PHILADELPHIA PA
19140-4642
US

V. Phone/Fax

Practice location:
  • Phone: 704-293-9856
  • Fax:
Mailing address:
  • Phone: 704-293-9856
  • Fax: 215-427-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005385-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004700
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: