Provider Demographics
NPI:1316332885
Name:MCGARVEY, JILL MARIE (RD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:MCGARVEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAIN ST STE 248
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3527
Mailing Address - Country:US
Mailing Address - Phone:207-413-1306
Mailing Address - Fax:
Practice Address - Street 1:120 MAIN ST STE 248
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3527
Practice Address - Country:US
Practice Address - Phone:207-413-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10167892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165772Medicaid