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General NPI Number Information
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NPI Number | 1265916167
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Entity Type | Individual
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Provider Name | JILL THIEDE MD, RD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | H200 MERCY CIRCLE
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City | CAMP PENDLETON
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State | CA
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Zip | 92055
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Country | US
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Telephone | 682-885-7960
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Fax |
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Provider Business Mailing Address
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Address Line | BLDG 41008 CAMP PENDLETON, CA
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City | APO
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State | AA
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Zip | 92055
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Country | US
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Telephone | 760-725-8007
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Fax | 760-725-6615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | DT85560
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024034082
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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Taxonomy #4
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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