Healthcare Provider Details

I. General information

NPI: 1982709515
Provider Name (Legal Business Name): DEBORAH CZERNECKI R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

9126 PHILANDER CHASE LN
BRIMFIELD IL
61517-9488
US

V. Phone/Fax

Practice location:
  • Phone: 800-320-8387
  • Fax:
Mailing address:
  • Phone: 309-446-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: