Healthcare Provider Details

I. General information

NPI: 1518081009
Provider Name (Legal Business Name): NANCY M LANNAN RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 FINLEY RD SUITE 102
DOWNERS GROVE IL
60515-1041
US

IV. Provider business mailing address

811 N KENSINGTON AVE
LA GRANGE PARK IL
60526-1468
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-6800
  • Fax: 630-495-8200
Mailing address:
  • Phone: 708-352-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: