MEDICARE: MRS. ROBBINETTE SUTTON-HALEY REGISTERED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	164.005293	IL

General Provider Information

NPI Number	:	1316290992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBBINETTE SUTTON-HALEY REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	11721 S ELIZABETH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-5119
Country	:	US
Telephone Number	:	312-622-0705
Fax Number	:	773-928-6776

Provider Business Practice Location Address
First Line	:	11721 S ELIZABETH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-5119
Country	:	US
Telephone Number	:	312-622-0705
Fax Number	:	773-928-6776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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