Provider Demographics
NPI:1699485383
Name:PRITZ, HALEY NICOLE (RD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:NICOLE
Last Name:PRITZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:NICOLE
Other - Last Name:PUCEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1287 HEALING STONE CT APT 10
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-9591
Mailing Address - Country:US
Mailing Address - Phone:815-274-4942
Mailing Address - Fax:
Practice Address - Street 1:3024 E EMPIRE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5402
Practice Address - Country:US
Practice Address - Phone:309-556-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered