=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558661066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN BLOCKLINGER CAMPOS RD, LDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2010
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1403 N VETERANS PKWY
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-663-3050
-----------------------------------------------------
Fax | 833-719-1241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1403 N VETERANS PKWY
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-663-3050
-----------------------------------------------------
Fax | 833-719-1241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 164001733
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 001848
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------