Provider Demographics
NPI:1821611872
Name:BARNES, MEGAN ELISE (RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:BARNES
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 1:725 SARAH LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2172
Mailing Address - Country:US
Mailing Address - Phone:847-946-4098
Mailing Address - Fax:
Practice Address - Street 1:725 SARAH LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2172
Practice Address - Country:US
Practice Address - Phone:847-946-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86167720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered