Individual
JILL M ROUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,CSO,CD
Contact information
Practice address
1580 COMMANCHE AVE, GREEN BAY, WI 54313-5751
(920) 435-8326
(920) 430-4659
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7226
(920) 445-7238
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1567
WI
Other
Enumeration date
12/08/2005
Last updated
02/13/2020
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