Provider Demographics
NPI:1942668827
Name:STABROWSKI, TAMARA (RD, LDN, CEDRD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:STABROWSKI
Suffix:
Gender:F
Credentials:RD, LDN, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 QUICK FIRE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-1029
Mailing Address - Country:US
Mailing Address - Phone:163-048-7728
Mailing Address - Fax:630-305-8549
Practice Address - Street 1:3747 QUICK FIRE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-1029
Practice Address - Country:US
Practice Address - Phone:163-048-7728
Practice Address - Fax:630-305-8549
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164000390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered