Healthcare Provider Details

I. General information

NPI: 1699208512
Provider Name (Legal Business Name): JANICE LYNETTE DOWELL R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE LYNETTE BARR

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N RUTLEDGE ST
SPRINGFIELD IL
62702-3721
US

IV. Provider business mailing address

932 N RUTLEDGE ST
SPRINGFIELD IL
62702-3721
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3948
  • Fax: 217-527-3209
Mailing address:
  • Phone: 217-788-3948
  • Fax: 217-527-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164001191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: