Provider Demographics
NPI:1043305659
Name:COLE, PATRICE JEANNE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:JEANNE
Last Name:COLE
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 1:5402 W. RACHAEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-692-8618
Mailing Address - Fax:
Practice Address - Street 1:5409 N. KNOXVILLE AVE.
Practice Address - Street 2:PROCTOR HOSPITAL
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-691-1056
Practice Address - Fax:309-689-6010
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK02352Medicare UPIN