NPI 1154875516 · live from the CMS NPI Registry
Peggy Balboa, RD
Dietitian, Registered in Chicago, IL. National Provider Identifier 1154875516, active.
NPI record
| NPI | 1154875516 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 4646 N Marine Dr, Suite A-4600, Chicago, IL 60640 |
| Practice phone | 773-564-7400 |
| Mailing address | 509 S Dryden Pl, Arlington Heights, IL 60005 |
| Enumerated | August 15, 2016 |
| Last updated | October 19, 2016 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 164.005248 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.