Provider Demographics
NPI:1144935560
Name:BINGHAM, BRITTANY ANN (RD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 WATERS EDGE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3280
Mailing Address - Country:US
Mailing Address - Phone:708-522-7235
Mailing Address - Fax:
Practice Address - Street 1:2963 WATERS EDGE CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-3280
Practice Address - Country:US
Practice Address - Phone:708-522-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008589133V00000X
IN37003400A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty