Provider Demographics
NPI:1538302161
Name:BREYER, MARJORIE ANN (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANN
Last Name:BREYER
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 1:545 STANDISH DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4436
Mailing Address - Country:US
Mailing Address - Phone:847-405-9282
Mailing Address - Fax:
Practice Address - Street 1:480 ELM PL
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2538
Practice Address - Country:US
Practice Address - Phone:847-405-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004155133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered