Provider Demographics
NPI:1376949156
Name:WEIDMAN, CHRISTINA ANNE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANNE
Last Name:WEIDMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:ANNE
Other - Last Name:JABLONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:3231 N CLIFTON AVE UNIT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3318
Mailing Address - Country:US
Mailing Address - Phone:630-306-5883
Mailing Address - Fax:
Practice Address - Street 1:3231 N CLIFTON AVE
Practice Address - Street 2:UNIT 2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:630-306-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006026133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered