Provider Demographics
NPI:1386680759
Name:COOLEY, CHRISTINE MARIE (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:COOLEY
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 1:375 MEDICAL GROUP
Mailing Address - Street 2:310 WEST LOSEY STREET
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225-5002
Mailing Address - Country:US
Mailing Address - Phone:618-256-7138
Mailing Address - Fax:
Practice Address - Street 1:375 MEDICAL GROUP
Practice Address - Street 2:310 WEST LOSEY STREET
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5002
Practice Address - Country:US
Practice Address - Phone:618-256-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered