Provider Demographics
NPI:1275725244
Name:PURI, VANDANA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:VANDANA
Middle Name:
Last Name:PURI
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 1:1130 S MICHIGAN AVE
Mailing Address - Street 2:APT 3103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2521
Mailing Address - Country:US
Mailing Address - Phone:312-212-6405
Mailing Address - Fax:
Practice Address - Street 1:1130 S MICHIGAN AVE
Practice Address - Street 2:APT 3103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2521
Practice Address - Country:US
Practice Address - Phone:312-212-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education