Healthcare Provider Details

I. General information

NPI: 1619851482
Provider Name (Legal Business Name): ELIZABETH KEANE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 N STERLING AVE APT 204
PALATINE IL
60067-1942
US

IV. Provider business mailing address

1185 N STERLING AVE APT 204
PALATINE IL
60067-1942
US

V. Phone/Fax

Practice location:
  • Phone: 224-830-3250
  • Fax:
Mailing address:
  • Phone: 224-830-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.022291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: