MEDICARE: EMILY WERNER RD, LDN

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	133VN1004X	Pediatric Nutrition Registered Dietitian	2537	MA

General Provider Information

NPI Number	:	1356468037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WERNER RD, LDN

Provider Business Mailing Address
First Line	:	211 E CHICAGO AVE
Second Line	:	SUITE 1050
City	:	CHICAGO
State	:	IL
Zip	:	60611-2661
Country	:	US
Telephone Number	:	312-944-6677
Fax Number	:	312-944-3346

Provider Business Practice Location Address
First Line	:	211 E CHICAGO AVE
Second Line	:	SUITE 1050
City	:	CHICAGO
State	:	IL
Zip	:	60611-2661
Country	:	US
Telephone Number	:	312-944-6677
Fax Number	:	312-944-3346

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/17/2011

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