Healthcare Provider Details

I. General information

NPI: 1063866721
Provider Name (Legal Business Name): IRENE FERNANDEZ GIL RDN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 S MAY ST # 1F
CHICAGO IL
60608-3359
US

IV. Provider business mailing address

421 S JACKSON ST
HINSDALE IL
60521-3946
US

V. Phone/Fax

Practice location:
  • Phone: 312-549-8866
  • Fax: 312-549-8861
Mailing address:
  • Phone: 312-560-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.006180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: