Provider Demographics
NPI:1962768465
Name:FORD, MOIRA RACHEL (RD, LDN)
Entity type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:RACHEL
Last Name:FORD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 LUCILLE LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5352
Mailing Address - Country:US
Mailing Address - Phone:630-439-4884
Mailing Address - Fax:
Practice Address - Street 1:1875 LUCILLE LN
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5352
Practice Address - Country:US
Practice Address - Phone:630-439-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004635133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered