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General NPI Number Information
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NPI Number | 1659718294
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Entity Type | Individual
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Provider Name | SANDRA L KURBY MPH, RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 5061 N PULASKI RD SUITE 300
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City | CHICAGO
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State | IL
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Zip | 60630-2706
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Country | US
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Telephone | 773-539-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 869 BURNING TRL
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City | CAROL STREAM
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State | IL
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Zip | 60188-9195
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Country | US
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Telephone | 630-231-3505
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 164.004013
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License Number State | IL
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