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General NPI Number Information
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NPI Number | 1538168976
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Entity Type | Individual
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Provider Name | JENNIFER LYNN GILLILAND MNT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 2100 W CENTRAL AVE STE 120
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City | TOLEDO
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State | OH
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Zip | 43606-3817
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Country | US
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Telephone | 419-291-6767
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Fax | 419-480-6608
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Provider Business Mailing Address
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Address Line | 1 SEAGATE # 800
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City | TOLEDO
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State | OH
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Zip | 43604-1558
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Country | US
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Telephone | 419-291-6767
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Fax | 419-480-6608
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 3682
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License Number State | OH
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