Healthcare Provider Details

I. General information

NPI: 1942677372
Provider Name (Legal Business Name): ASHLEY PETERS MBA, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 E 1200 NORTH RD
ONARGA IL
60955-7534
US

IV. Provider business mailing address

1372 E 1200 NORTH RD
ONARGA IL
60955-7534
US

V. Phone/Fax

Practice location:
  • Phone: 815-471-7808
  • Fax:
Mailing address:
  • Phone: 815-471-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164006404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: