Healthcare Provider Details

I. General information

NPI: 1871559104
Provider Name (Legal Business Name): KRISTIN R DWYER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN R JOHNSON

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N HIGHLAND AVE
AURORA IL
60506-1449
US

IV. Provider business mailing address

1133 SHOREWOOD CT
GLENDALE HEIGHTS IL
60139-3786
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-5899
  • Fax:
Mailing address:
  • Phone: 630-682-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: