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NPI Code Detail

MEDICARE: JENNIFER LYNN GILLILAND MNT

MEDICARE: JENNIFER LYNN GILLILAND MNT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian3682OH

General Provider Information

NPI Number : 1538168976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN GILLILAND MNT
Provider Business Mailing Address
First Line : 1 SEAGATE # 800
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1558
Country : US
Telephone Number : 419-291-6767
Fax Number : 419-480-6608
Provider Business Practice Location Address
First Line : 2100 W CENTRAL AVE STE 120
Second Line :
City : TOLEDO
State : OH
Zip : 43606-3817
Country : US
Telephone Number : 419-291-6767
Fax Number : 419-480-6608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 05/20/2020

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Directions to “ JENNIFER LYNN GILLILAND MNT” Practice Location

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