MEDICARE: VINCENZA QUAID 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	164004073	IL

General Provider Information

NPI Number	:	1588108005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENZA QUAID RD, LDN

Provider Business Mailing Address
First Line	:	223 WASHINGTON ST
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-5027
Country	:	US
Telephone Number	:	847-323-5047
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 WASHINGTON ST
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-5027
Country	:	US
Telephone Number	:	847-323-5047
Fax Number	:

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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