Individual
MS. JACQLENE NICHOLLE TILLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDN, CNSC
Contact information
Practice address
725 IRVING AVE, SUITE 504, SYRACUSE, NY 13210-1603
(315) 464-8435
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-8435
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
007796
NY
Other
Enumeration date
04/20/2015
Last updated
04/20/2015
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