Healthcare Provider Details

I. General information

NPI: 1891613170
Provider Name (Legal Business Name): CHRISTINA MARIE BORDIGNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6N347 FAIRWAY LN
ITASCA IL
60143-1943
US

IV. Provider business mailing address

6N347 FAIRWAY LN
ITASCA IL
60143-1943
US

V. Phone/Fax

Practice location:
  • Phone: 630-816-0982
  • Fax:
Mailing address:
  • Phone: 630-816-0982
  • 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: