Healthcare Provider Details

I. General information

NPI: 1972814283
Provider Name (Legal Business Name): CHRISTINE M GILLETTE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE MARIE GILLETTE RD

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E ROOSEVELT ROAD, SUITE 201
WHEATON IL
60187-5200
US

IV. Provider business mailing address

29624 NETWORK PL
CHICAGO IL
60673-1296
US

V. Phone/Fax

Practice location:
  • Phone: 630-752-8823
  • Fax: 630-480-0057
Mailing address:
  • Phone: 262-245-0535
  • Fax: 262-245-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1970-29
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164-004-139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: