Provider Demographics
NPI:1598499048
Name:PARR, MICHAELA (RDN)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:PARR
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W ADAMS ST APT 704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3609
Mailing Address - Country:US
Mailing Address - Phone:610-888-7158
Mailing Address - Fax:
Practice Address - Street 1:180 W ADAMS ST APT 704
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3609
Practice Address - Country:US
Practice Address - Phone:610-888-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty