Provider Demographics
NPI:1730562703
Name:LITWIN, NICOLE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LITWIN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 W FULLERTON AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2562
Mailing Address - Country:US
Mailing Address - Phone:931-319-3533
Mailing Address - Fax:
Practice Address - Street 1:3247 W FULLERTON AVE APT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2562
Practice Address - Country:US
Practice Address - Phone:931-319-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered