Provider Demographics
NPI:1124427919
Name:NELLIGAN, JILL (RD, LDN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#1033
Mailing Address - Street 2:729 BRIDGE ST STE 1
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191
Mailing Address - Country:US
Mailing Address - Phone:508-591-3168
Mailing Address - Fax:
Practice Address - Street 1:128 LAMBERTS LANE
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025
Practice Address - Country:US
Practice Address - Phone:413-768-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered