MEDICARE: MRS. DANA CHERYSE HOWSE RD/LDN

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	164004230	IL

General Provider Information

NPI Number	:	1467900530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA CHERYSE HOWSE RD/LDN

Provider Business Mailing Address
First Line	:	4121 W LAKE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-1719
Country	:	US
Telephone Number	:	773-826-7066
Fax Number	:	773-826-2109

Provider Business Practice Location Address
First Line	:	4121 W LAKE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-1719
Country	:	US
Telephone Number	:	773-826-7066
Fax Number	:	773-826-2109

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

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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