Provider Demographics
NPI:1780977686
Name:JANK, JILL D (MS, RD, LMNT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:JANK
Suffix:
Gender:F
Credentials:MS, RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1946
Mailing Address - Country:US
Mailing Address - Phone:402-488-8851
Mailing Address - Fax:
Practice Address - Street 1:5000 STARLING DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1946
Practice Address - Country:US
Practice Address - Phone:402-488-8851
Practice Address - Fax:402-488-8851
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE86133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252055-00Medicaid