Individual
JILL CAROLAND BLASINGAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DTR
Contact information
Practice address
116 N PAULINE ST, MEMPHIS, TN 38104-1005
(901) 523-4952
Mailing address
116 N PAULINE ST, MEMPHIS, TN 38104-1005
(901) 523-8990
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
1092925
TN
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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