Provider Demographics
NPI:1114520244
Name:DELAURENTIS, JAMIE FRANCES (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:FRANCES
Last Name:DELAURENTIS
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E SOUTH WATER ST APT 4804
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4159
Mailing Address - Country:US
Mailing Address - Phone:708-407-0505
Mailing Address - Fax:
Practice Address - Street 1:360 E SOUTH WATER ST APT 4804
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4159
Practice Address - Country:US
Practice Address - Phone:708-407-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86101215133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered