Provider Demographics
NPI:1376248799
Name:PIPER, DARLENE (RD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:PIPER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3013
Mailing Address - Country:US
Mailing Address - Phone:309-531-7692
Mailing Address - Fax:
Practice Address - Street 1:202 S OAK ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3013
Practice Address - Country:US
Practice Address - Phone:309-531-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86109515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered