Healthcare Provider Details

I. General information

NPI: 1629847850
Provider Name (Legal Business Name): CARLY PINE APTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 N CLARK ST STE 400
CHICAGO IL
60614-7725
US

IV. Provider business mailing address

165 N CANAL ST APT 506
CHICAGO IL
60606-1504
US

V. Phone/Fax

Practice location:
  • Phone: 312-533-1754
  • Fax:
Mailing address:
  • Phone: 847-226-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: