Healthcare Provider Details

I. General information

NPI: 1457336414
Provider Name (Legal Business Name): ERIN M PARIS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 CRESSA CT
SPRINGFIELD IL
62704-3279
US

IV. Provider business mailing address

1613 CRESSA CT
SPRINGFIELD IL
62704-3279
US

V. Phone/Fax

Practice location:
  • Phone: 217-622-5223
  • Fax: 217-726-0300
Mailing address:
  • Phone: 217-622-5223
  • Fax: 217-726-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164-003845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: