Basic Information
| Provider Information | |||||||||
| NPI: | 1528458601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUMA | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | JANEL | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674018537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858258221 | ||||||||
| FaxNumber: | 7854523294 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674018537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858258221 | ||||||||
| FaxNumber: | 7854523294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2015 | ||||||||
| LastUpdateDate: | 11/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 20111677OA | 05 | KS | MEDICAID |