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NPI Code Detail

MEDICARE: MRS. PRISCILLA NWAMY MONU MS,RD,LDN

MEDICARE: MRS. PRISCILLA NWAMY MONU MS,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
1133N00000XNutritionist164.004009IL
2133V00000XRegistered Dietitian164.004009IL
3133VN1004XPediatric Nutrition Registered Dietitian164.004009IL
4133VN1005XRenal Nutrition Registered Dietitian164.004009IL
5133VN1006XMetabolic Nutrition Registered Dietitian164.004009IL

General Provider Information

NPI Number : 1669703666
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PRISCILLA NWAMY MONU MS,RD,LDN
Provider Business Mailing Address
First Line : 2924 W 83RD ST
Second Line : 2924 W 83RD ST
City : CHICAGO
State : IL
Zip : 60652-3404
Country : US
Telephone Number : 773-995-6300
Fax Number : 773-995-6179
Provider Business Practice Location Address
First Line : 1029 E 130TH ST
Second Line : 1029 E 130TH ST
City : CHICAGO
State : IL
Zip : 60628-6908
Country : US
Telephone Number : 773-995-6300
Fax Number : 773-995-6179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2010
Last Update Date : 01/15/2010

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