Healthcare Provider Details

I. General information

NPI: 1700183480
Provider Name (Legal Business Name): ERIN ZEPP RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN SPENNER RD

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E CARPENTER ST
SPRINGFIELD IL
62702-5185
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3948
  • Fax: 217-527-3209
Mailing address:
  • Phone: 217-588-2624
  • Fax: 217-757-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.005410
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: