Provider Demographics
NPI:1356360671
Name:YEE, JERI L (RD)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:L
Last Name:YEE
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 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-655-2000
Mailing Address - Fax:
Practice Address - Street 1:4911 N EXECUTIVE DR
Practice Address - Street 2:MATERNAL FETAL DIAGNOSTIC CENTER
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4896
Practice Address - Country:US
Practice Address - Phone:309-683-6708
Practice Address - Fax:309-683-6734
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
207657OtherMEDICARE GROUP NO.
207657OtherMEDICARE GROUP NO.
Q02639Medicare UPIN