Healthcare Provider Details

I. General information

NPI: 1598773707
Provider Name (Legal Business Name): LYNN DANFORD M.S., C.D.E., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 N RICHMOND ST
CHICAGO IL
60618-1406
US

IV. Provider business mailing address

4338 N RICHMOND ST
CHICAGO IL
60618-1406
US

V. Phone/Fax

Practice location:
  • Phone: 773-279-1810
  • Fax: 773-279-0243
Mailing address:
  • Phone: 773-279-1810
  • Fax: 773-279-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: