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NPI Code Detail

MEDICARE: PATRICIA M KNISLEY RD, LD

MEDICARE: PATRICIA M KNISLEY RD, LD
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
1133V00000XRegistered Dietitian4386OH

General Provider Information

NPI Number : 1508865452
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA M KNISLEY RD, LD
Provider Business Mailing Address
First Line : 5000 S 5TH AVE
Second Line : FOOD AND NUTRITION SERVICES (120D)
City : HINES
State : IL
Zip : 60141-3030
Country : US
Telephone Number : 708-202-8387
Fax Number :
Provider Business Practice Location Address
First Line : 5000 S 5TH AVE
Second Line : FOOD AND NUTRITION SERVICES (120D)
City : HINES
State : IL
Zip : 60141-3030
Country : US
Telephone Number : 708-202-8387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 08/06/2014

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Directions to “ PATRICIA M KNISLEY RD, LD” Practice Location

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