Provider Demographics
NPI:1316128192
Name:HERREJON, KATRINA LOUISE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LOUISE
Last Name:HERREJON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LOUISE
Other - Last Name:SPRENGELMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:9977 WOODS DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-663-8540
Practice Address - Fax:847-663-1015
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-004790133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164-004790OtherIL STATE LIC
IL164-004790OtherIL STATE LIC
ILK49524Medicare PIN