Provider Demographics
NPI:1578863460
Name:VANACORA, RENEE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:VANACORA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:OFFERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:2025 S. CHICAGO ST
Mailing Address - Street 2:PRIMARY CARE JOLIET
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-3168
Mailing Address - Country:US
Mailing Address - Phone:815-726-2200
Mailing Address - Fax:
Practice Address - Street 1:2025 S. CHICAGO ST
Practice Address - Street 2:PRIMARY CARE JOLIET
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-3168
Practice Address - Country:US
Practice Address - Phone:815-726-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002994133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered