Healthcare Provider Details

I. General information

NPI: 1730271917
Provider Name (Legal Business Name): LINDA ANN HARRIS-TEACH RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 ELLIOTT ST
KEWANEE IL
61443-2779
US

IV. Provider business mailing address

3010 OXFORD DR
BETTENDORF IA
52722-2672
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-6890
  • Fax:
Mailing address:
  • Phone: 563-355-5643
  • 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: