MEDICARE: RITA FAYCURRY 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	133V00000X	Registered Dietitian	164006839	IL

General Provider Information

NPI Number	:	1740639830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA FAYCURRY RD, LDN

Provider Business Mailing Address
First Line	:	111 NORTH AVE
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3282
Country	:	US
Telephone Number	:	630-635-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SOUTH MONROE STREET FIRST FLOOR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-5834
Country	:	US
Telephone Number	:	630-635-5950
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	05/07/2023

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