Basic Information
Provider Information | |||||||||
NPI: | 1932349719 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WILLIAMS | ||||||||
FirstName: | CHERYL | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS, RDN, LDN, CDCES | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BELL | ||||||||
OtherFirstName: | CHERYL | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RD, CDCES | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1475 E BELVIDERE RD UNIT 385 | ||||||||
Address2: |   | ||||||||
City: | GRAYSLAKE | ||||||||
State: | IL | ||||||||
PostalCode: | 600302026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473880603 | ||||||||
FaxNumber: | 8475357399 | ||||||||
Practice Location | |||||||||
Address1: | 1475 E BELVIDERE RD UNIT 385 | ||||||||
Address2: |   | ||||||||
City: | GRAYSLAKE | ||||||||
State: | IL | ||||||||
PostalCode: | 600302026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8473880603 | ||||||||
FaxNumber: | 8475357399 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/06/2009 | ||||||||
LastUpdateDate: | 04/20/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/20/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | 164.003777 | IL | N |   | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133VN1201X | 164.003777 | IL | N |   |   |   |   | 133V00000X | 164003777 | IL | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.