Healthcare Provider Details

I. General information

NPI: 1144597360
Provider Name (Legal Business Name): PAULA K CELANI RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12935 GREGORY ST
BLUE ISLAND IL
60406-2428
US

IV. Provider business mailing address

14417 S 90TH CT
ORLAND PARK IL
60462-6213
US

V. Phone/Fax

Practice location:
  • Phone: 708-824-4659
  • Fax:
Mailing address:
  • Phone: 708-873-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164L002279
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number164.002279
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.002279
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number164.002279
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number164.002279
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164.002279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: