Provider Demographics
NPI:1205228558
Name:SCHALLHORN, ANA CRISTINA (RD LDN CLC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CRISTINA
Last Name:SCHALLHORN
Suffix:
Gender:F
Credentials:RD LDN CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 N GLEN CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4644
Mailing Address - Country:US
Mailing Address - Phone:309-256-7959
Mailing Address - Fax:
Practice Address - Street 1:4813 N GLEN CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4644
Practice Address - Country:US
Practice Address - Phone:309-256-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered