Provider Demographics
NPI:1699521849
Name:TYLISZ, HAILEIY NICOLE (RD)
Entity type:Individual
Prefix:
First Name:HAILEIY
Middle Name:NICOLE
Last Name:TYLISZ
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 1:21 KRISTIN DR UNIT 813
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3336
Mailing Address - Country:US
Mailing Address - Phone:219-877-4875
Mailing Address - Fax:
Practice Address - Street 1:1531 S GROVE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5240
Practice Address - Country:US
Practice Address - Phone:817-205-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86117814133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered