MEDICARE: VALERIE ANN EARLY RD, LDN, R.PH.T.

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	164.003605	IL
2	183700000X	Pharmacy Technician	049.158529	IL

General Provider Information

NPI Number	:	1558796441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE ANN EARLY RD, LDN, R.PH.T.

Provider Business Mailing Address
First Line	:	740 MAPLE LN
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-3010
Country	:	US
Telephone Number	:	847-985-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1443 W SCHAUMBURG RD
Second Line	:	STE 22
City	:	SCHAUMBURG
State	:	IL
Zip	:	60194-4065
Country	:	US
Telephone Number	:	847-985-1200
Fax Number	:

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

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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