Provider Demographics
NPI:1760049415
Name:MOSER, LIBBY MICAELA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:MICAELA
Last Name:MOSER
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N STATE ST FL 15
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3206
Mailing Address - Country:US
Mailing Address - Phone:312-566-7079
Mailing Address - Fax:
Practice Address - Street 1:1 N STATE ST FL 15
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3206
Practice Address - Country:US
Practice Address - Phone:312-566-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86088997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
133V00000XOtherDIETITIAN, REGISTERED