Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038012993 | IL |
NPI | 1083097372 |
---|---|
Provider Name | Christie Drzewiecki |
First Address | Wood Dale, IL 60191-1978 |
Second Address | Wood Dale, IL 60191-1978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2015 |
Last Update Date | 04/08/2020 |