Healthcare Provider Details

I. General information

NPI: 1073737011
Provider Name (Legal Business Name): KAREN ANN HUTTON RD, LDN, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 NE GLEN OAK AVE
PEORIA IL
61636-0002
US

IV. Provider business mailing address

221 NE GLEN OAK AVE
PEORIA IL
61636-0002
US

V. Phone/Fax

Practice location:
  • Phone: 309-672-4957
  • Fax: 309-672-4953
Mailing address:
  • Phone: 309-672-4957
  • Fax: 309-672-4953

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: