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NPI Code Detail

MEDICARE: KRISTIN R DWYER RD

MEDICARE: KRISTIN R DWYER RD
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
1133V00000XRegistered DietitianIL

General Provider Information

NPI Number : 1871559104
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN R DWYER RD
Provider Business Mailing Address
First Line : 1133 SHOREWOOD CT
Second Line :
City : GLENDALE HEIGHTS
State : IL
Zip : 60139-3786
Country : US
Telephone Number : 630-682-8556
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N HIGHLAND AVE
Second Line :
City : AURORA
State : IL
Zip : 60506-1449
Country : US
Telephone Number : 630-801-5899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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Directions to “ KRISTIN R DWYER RD” Practice Location

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