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NPI Code Detail

MEDICARE: MRS. PAULA JEAN HALL RD LDN

MEDICARE: MRS. PAULA JEAN HALL 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
1133V00000XRegistered Dietitian164.001752IL

General Provider Information

NPI Number : 1710287818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAULA JEAN HALL RD LDN
Provider Business Mailing Address
First Line : 825 CONSTITUTION RD
Second Line :
City : NEW LENOX
State : IL
Zip : 60451-2087
Country : US
Telephone Number : 815-370-5631
Fax Number :
Provider Business Practice Location Address
First Line : 2025 S CHICAGO ST
Second Line : 1051 ESSINGTON RD.
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-726-2200
Fax Number : 815-846-2665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2010
Last Update Date : 10/25/2010

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