MS. JACQLENE NICHOLLE TILLMES (NPI# 1811384639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811384639 |
| Entity Type | Individual |
| Full Name | MS. JACQLENE NICHOLLE TILLMES |
| Credential | RD, CDN, CNSC |
| Practice Address |
725 Irving Ave Suite 504 Syracuse NY 13210-1603 |
| Mailing Address |
750 E Adams St Syracuse NY 13210-2306 |
| Practice Telephone | 3154648435 |
| Mailing Telephone | 3154648435 |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2015-04-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 007796 | NY | Dietary & Nutritional Service Providers |
| Street Address |
725 IRVING AVE SUITE 504 |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13210-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154321826 | Glenda J Hungerford | Nurse Anesthetist, Certified Registered | 725 Irving Ave, Suite 402, Syracuse, NY 13210 | 2005-07-26 |
| 1659937456 | Stephanie Locicero | Physician Assistant | 725 Irving Ave, Syracuse, NY 13210-1603 | 2019-05-16 |
| 1023526522 | John Stepan Pototsky | Nurse Anesthetist, Certified Registered | 725 Irving Ave, Syracuse, NY 13210-1603 | 2018-01-18 |
| 1891205043 | Quentin Lawrence Archer | Physician Assistant | 725 Irving Ave, Syracuse, NY 13210-1603 | 2017-10-02 |
| 1316390834 | Julie Albanese | Nurse Practitioner | 725 Irving Ave, Suite 504, Syracuse, NY 13210-1603 | 2016-07-20 |
| 1679928311 | Jo-anne Furcinito | Nurse Practitioner | 725 Irving Ave, Syracuse, NY 13210-1603 | 2016-05-02 |
| 1760874150 | Stacey L Messe | Dietitian, Registered | 725 Irving Ave, Suite 504, Syracuse, NY 13210-1603 | 2015-02-23 |
| 1376946715 | Cheryl Palmer | Counselor | 725 Irving Ave, Suite 302, Syracuse, NY 13210-1603 | 2014-09-30 |
| 1396163465 | Caroline Burns Stroup | Obstetrics & Gynecology | 725 Irving Ave, Suite 600, Syracuse, NY 13210 | 2014-04-04 |
| 1396171401 | Ashok Rijhwani | Surgery | 725 Irving Ave, Ste. 401, Syracuse, NY 13210-1603 | 2013-09-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558973586 | Maizie Marie Shaw | Social Worker | 660 Madison Street, Syracuse, NY 13210 | 2020-08-20 |
| 1427666916 | Christine Marie Welker | Registered Nurse | 735 Irving Avenue, Syracuse, NY 13210 | 2020-07-21 |
| 1386263994 | Ashwini Krishna Ashwath | Student in an Organized Health Care Education/Training Program | 750 E. Adams Street, Syracuse, Ny 13210, Syracuse, NY 13210 | 2020-04-14 |
| 1073142329 | Kamala Ojha | Student in an Organized Health Care Education/Training Program | 750-east Adam's Street, Syracuse, NY 13210 | 2020-04-07 |
| 1003442369 | Brittany Nicole Lippert | Counselor | 615 Madison St, Syracuse, NY 13210 | 2020-03-19 |
| 1902430499 | Dkt Physician Pllc | Internal Medicine | 475 Irving Ave, Suite 410, Syracuse, NY 13210 | 2020-02-24 |
| 1376194720 | Sarah Van Eenenaam | Physician Assistant | Adult Cardiac Surgery, 750 East Adams St, Syracuse, NY 13210 | 2019-09-26 |
| 1265099022 | Michelle Gallagher | Psychologist | Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210 | 2019-05-28 |
| 1639659428 | Francesca Wanda Cotrupe | Physical Medicine & Rehabilitation | Upstate Medical University Hospital, 750 E Adams Street, Syracuse, NY 13210 | 2018-08-21 |
| 1700370327 | Dallin Lindahl | Physical Medicine & Rehabilitation | 750 E Adams St # Jh308, Syracuse, NY 13210 | 2018-06-18 |
| Find all providers in zip 13210 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194336248 | Amanda E Vadala | Dietitian, Registered | 216 Conklin Ave, Syracuse, NY 13206 | 2020-08-12 |
| 1386252716 | Gregory M Belzak | Dietitian, Registered | 108 Ormsby Dr, Syracuse, NY 13219-3117 | 2020-07-22 |
| 1871135863 | Leah Webster | Dietitian, Registered | 100 Huckleberry Ln, Syracuse, NY 13219-2114 | 2019-10-11 |
| 1376019711 | Rachel Lauren Watkins | Dietitian, Registered | 3300 James St Ste 4, Syracuse, NY 13206-2670 | 2018-10-23 |
| 1790221984 | Kathleen Mary Bump | Dietitian, Registered | 300 Halton Rd, Syracuse, NY 13224-2228 | 2017-01-11 |
| 1093017485 | Jennifer A Brady | Dietitian, Registered | 1966 S 2590 W, Syracuse, UT 84075-7022 | 2010-11-17 |
| 1518271808 | Heather Lynn Neely | Dietitian, Registered | 765 Irving Avenue, Marley Education Center, Suite 229, Syracuse, NY 13210 | 2010-07-29 |
| 1942332804 | Cynthia Todd | Dietitian, Registered | 600 S. Wilbur Ave., Horizons Clinic, Arc of Onondaga, Syracuse, NY 13204 | 2007-03-09 |
| 1770529497 | Marilyn Frances Crosby | Dietitian, Registered | 3779 Pegasus Circle, Syracuse, NY 13209-9504 | 2006-06-21 |
| 1275500621 | Donna L Acox | Dietitian, Registered | 800 S Wilbur Ave, Syracuse, NY 13204-2732 | 2006-03-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.