Provider Demographics
NPI:1063863371
Name:WHITE, DANIEL BENJAMIN (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BENJAMIN
Last Name:WHITE
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 NORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5991
Mailing Address - Country:US
Mailing Address - Phone:630-962-1799
Mailing Address - Fax:
Practice Address - Street 1:1070 NORWOOD LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5991
Practice Address - Country:US
Practice Address - Phone:630-962-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered