Healthcare Provider Details

I. General information

NPI: 1407648900
Provider Name (Legal Business Name): SYMONE MERIWETHER ND, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N MICHIGAN AVE STE 810
CHICAGO IL
60601-5902
US

IV. Provider business mailing address

131 KINNICK DR
GREENWOOD IN
46143-5537
US

V. Phone/Fax

Practice location:
  • Phone: 872-240-4807
  • Fax:
Mailing address:
  • Phone: 765-210-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number164012186
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number164012186
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: