Provider Demographics
NPI:1063722379
Name:RONDINELLI NUTRITION CONSULTING, LLC
Entity type:Organization
Organization Name:RONDINELLI NUTRITION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RD,CDE
Authorized Official - Phone:773-802-2254
Mailing Address - Street 1:1286 RIVERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3321
Mailing Address - Country:US
Mailing Address - Phone:773-802-2254
Mailing Address - Fax:
Practice Address - Street 1:720 BROM CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6531
Practice Address - Country:US
Practice Address - Phone:773-802-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164003404133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty