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General NPI Number Information
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NPI Number | 1740639830
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Entity Type | Individual
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Provider Name | RITA FAYCURRY RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 05/07/2023
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Provider Practice Location Address
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Address Line | 113 SOUTH MONROE STREET FIRST FLOOR
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5834
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Country | US
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Telephone | 630-635-5950
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Fax |
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Provider Business Mailing Address
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Address Line | 111 NORTH AVE
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City | BARRINGTON
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State | IL
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Zip | 60010-3282
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Country | US
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Telephone | 630-635-5950
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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 | 164006839
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License Number State | IL
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