Provider Demographics
NPI:1588007629
Name:EGAN, DIANE L (NUTRITIONIST)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:EGAN
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20303 CRAWFORD AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1073
Mailing Address - Country:US
Mailing Address - Phone:708-748-4487
Mailing Address - Fax:708-748-5328
Practice Address - Street 1:20303 CRAWFORD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-748-4487
Practice Address - Fax:708-748-5328
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist