Healthcare Provider Details

I. General information

NPI: 1316128192
Provider Name (Legal Business Name): KATRINA LOUISE HERREJON MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA LOUISE SPRENGELMEYER MS, RD, LDN

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR 1ST FLOOR
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8540
  • Fax: 847-663-1015
Mailing address:
  • Phone: 847-570-1206
  • Fax: 847-570-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number164-004790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: