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General NPI Number Information
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NPI Number | 1346436508
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Entity Type | Individual
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Provider Name | CAREN BALTASI LDN,CCN
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Gender | Female
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 2525 WAUKEGAN RD SUITE 255
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City | BANNOCKBURN
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State | IL
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Zip | 60015-5514
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Country | US
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Telephone | 847-405-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 WAUKEGAN RD SUITE 255
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City | BANNOCKBURN
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State | IL
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Zip | 60015-5514
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Country | US
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Telephone | 847-405-7611
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 164.004395
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License Number State | IL
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