NPI 1639393556 · live from the CMS NPI Registry
Tracy R Anderson, MS, RD, LDN
Dietitian, Registered in Peoria, IL. National Provider Identifier 1639393556, active.
NPI record
| NPI | 1639393556 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 221 Ne Glen Oak Ave, Peoria, IL 61636 |
| Practice phone | 309-672-4240 |
| Mailing address | 323 S 6th St, Pekin, IL 61554 |
| Enumerated | April 12, 2007 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
| Other names | Tracy Gannon |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 164.003776 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.