Provider Demographics
NPI:1265318331
Name:SMITH, JILLIAN (RDN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ITALY ST
Mailing Address - Street 2:
Mailing Address - City:MOCANAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18655-1417
Mailing Address - Country:US
Mailing Address - Phone:570-479-8649
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE # 15-09
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-214-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric