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NPI Code Detail

MEDICARE: CHRISTINE CONOVER RD, LDN

MEDICARE: CHRISTINE CONOVER 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 Dietitian164006226IL

General Provider Information

NPI Number : 1942669544
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE CONOVER RD, LDN
Provider Business Mailing Address
First Line : 3103 ERNEST DR
Second Line :
City : SANDWICH
State : IL
Zip : 60548-7061
Country : US
Telephone Number : 815-274-2119
Fax Number :
Provider Business Practice Location Address
First Line : 64 MAIN ST
Second Line :
City : OSWEGO
State : IL
Zip : 60543-9893
Country : US
Telephone Number : 630-519-1010
Fax Number : 630-405-7209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2016
Last Update Date : 04/15/2021

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Directions to “ CHRISTINE CONOVER RD, LDN” Practice Location

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