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General NPI Number Information
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NPI Number | 1689845125
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Entity Type | Individual
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Provider Name | JILL NICHOLE DAVIS R.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 611 CASCADE WEST PKWY SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2107
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Country | US
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Telephone | 248-475-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 4986 N ADAMS RD SUITE E
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City | ROCHESTER
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State | MI
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Zip | 48306-5017
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Country | US
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Telephone | 248-475-4880
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Fax | 248-475-4881
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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 | 945341
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License Number State | MI
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