Healthcare Provider Details

I. General information

NPI: 1326270133
Provider Name (Legal Business Name): BRITTANY MARIE WINSHIP RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MARIE DONLON

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BROADWAY ST
QUINCY IL
62301-3713
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4096
US

V. Phone/Fax

Practice location:
  • Phone: 217-277-4070
  • Fax: 217-221-4013
Mailing address:
  • Phone: 217-222-6550
  • Fax: 217-277-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164005114
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: