Provider Demographics
NPI:1578844312
Name:STRUSS, REGINA MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:STRUSS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2342
Mailing Address - Country:US
Mailing Address - Phone:309-787-0273
Mailing Address - Fax:
Practice Address - Street 1:201 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2342
Practice Address - Country:US
Practice Address - Phone:309-787-0273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005681133V00000X
IA001998133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered