Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038006084 | IL |
NPI | 1174723985 |
---|---|
Provider Name | Dr. Vilija R Kerelis |
First Address | Palos Heights, IL 60463-2269 |
Second Address | Palos Heights, IL 60463-2269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |