Provider Demographics
NPI:1417134412
Name:CORLEONE, JILL (RD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CORLEONE
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 1:7190 HAWAII KAI DR APT 272
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-4109
Mailing Address - Country:US
Mailing Address - Phone:808-348-0670
Mailing Address - Fax:407-892-4767
Practice Address - Street 1:7190 HAWAII KAI DR APT 272
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-4109
Practice Address - Country:US
Practice Address - Phone:808-348-0670
Practice Address - Fax:407-892-4767
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5126133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered