Healthcare Provider Details

I. General information

NPI: 1952724312
Provider Name (Legal Business Name): CRISTINE S. WILLIAMS RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 W 79TH ST
BURBANK IL
60459-1133
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-761-9606
  • Fax:
Mailing address:
  • Phone: 847-890-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164000935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: