Provider Demographics
NPI:1710087002
Name:WHITE, DANA MARIE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:2801 FINLEY RD STE 220
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1039
Practice Address - Country:US
Practice Address - Phone:630-261-9393
Practice Address - Fax:630-282-5186
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15287Medicare ID - Type UnspecifiedREGISTERED DIETITIAN