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General NPI Number Information
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NPI Number | 1144048570
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Entity Type | Individual
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Provider Name | ERIN N BANNISTER MS, RDN, LDN, CLC
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Gender |
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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Country | US
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Telephone | 312-864-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 431 N HUMPHREY AVE APT J2
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City | OAK PARK
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State | IL
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Zip | 60302-2446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 164009291
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | 164009291
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164009291
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License Number State | IL
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