Provider Demographics
NPI:1619469970
Name:ALCORDO, NABILA (RD)
Entity Type:Individual
Prefix:
First Name:NABILA
Middle Name:
Last Name:ALCORDO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2664
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1093
Mailing Address - Country:US
Mailing Address - Phone:630-697-6913
Mailing Address - Fax:
Practice Address - Street 1:18210 LA GRANGE RD STE 201
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7725
Practice Address - Country:US
Practice Address - Phone:708-945-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007291133V00000X
133V00000X
IL804655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered