Healthcare Provider Details

I. General information

NPI: 1942571666
Provider Name (Legal Business Name): ANNE GUINANE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12935 GREGORY ST
BLUE ISLAND IL
60406-2428
US

IV. Provider business mailing address

10459 S TALMAN AVE
CHICAGO IL
60655-1620
US

V. Phone/Fax

Practice location:
  • Phone: 708-824-4659
  • Fax:
Mailing address:
  • Phone: 708-715-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005621
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number164.005621
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164.005621
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number164.005621
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number164.005621
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164.005621
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: