Healthcare Provider Details

I. General information

NPI: 1134620941
Provider Name (Legal Business Name): STEPHANIE INEMAN MS, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E LAKE ST STE 226
CHICAGO IL
60601-7650
US

IV. Provider business mailing address

260 MEADOW RIDGE TRL
DOYLESTOWN OH
44230-1636
US

V. Phone/Fax

Practice location:
  • Phone: 866-710-1018
  • Fax:
Mailing address:
  • Phone: 330-933-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number6731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: