Provider Demographics
NPI:1942378385
Name:NIJHAWAN, ANILA (RD)
Entity Type:Individual
Prefix:MS
First Name:ANILA
Middle Name:
Last Name:NIJHAWAN
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 1:3235 VOLLMER ROAD
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2007
Mailing Address - Country:US
Mailing Address - Phone:708-957-8746
Mailing Address - Fax:708-206-0095
Practice Address - Street 1:3235 VOLLMER RD
Practice Address - Street 2:SUITE # 120
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2013
Practice Address - Country:US
Practice Address - Phone:708-957-8746
Practice Address - Fax:708-206-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202367Medicare PIN