MEDICARE: JANET FRAKER L.D.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	164-0008000	IL

General Provider Information

NPI Number	:	1053683524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET FRAKER L.D.N.

Provider Business Mailing Address
First Line	:	11927 LANARK CT
Second Line	:
City	:	CALEDONIA
State	:	IL
Zip	:	61011-9794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N UNIVERSITY DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5317
Country	:	US
Telephone Number	:	815-387-2500
Fax Number	:	815-387-2590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2012
Last Update Date	:	01/31/2012

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