Provider Demographics
NPI:1639328495
Name:TOWNS, RUTH E (LDN, CDE)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:E
Last Name:TOWNS
Suffix:
Gender:F
Credentials:LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 NORTH ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-624-3250
Mailing Address - Fax:309-624-3257
Practice Address - Street 1:8600 NORTH ROUTE 91
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-624-3250
Practice Address - Fax:309-624-3257
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004417133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840OtherMEDICARE GROUP PTAN
IL809840OtherMEDICARE GROUP PTAN