Provider Demographics
NPI:1497110324
Name:WILLIAMS, GINNY KRISTINE (RDN)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:KRISTINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:KRISTINE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3039 COUNTY ROAD 900 E
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:IL
Mailing Address - Zip Code:61840-9703
Mailing Address - Country:US
Mailing Address - Phone:217-840-3142
Mailing Address - Fax:
Practice Address - Street 1:3039 COUNTY ROAD 900 E
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:IL
Practice Address - Zip Code:61840-9703
Practice Address - Country:US
Practice Address - Phone:217-840-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered