Provider Demographics
NPI:1568578706
Name:AXIOTIS, DEBBIE (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:AXIOTIS
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:DESPINA
Other - Middle Name:
Other - Last Name:AXIOTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RD LDN
Mailing Address - Street 1:8230 ELMWOOD AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2996
Mailing Address - Country:US
Mailing Address - Phone:847-679-6988
Mailing Address - Fax:
Practice Address - Street 1:8230 ELMWOOD AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2996
Practice Address - Country:US
Practice Address - Phone:847-679-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133NN1002X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Not Answered133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11667Medicare ID - Type Unspecified