Provider Demographics
NPI:1942736848
Name:DARNALL, ELLEN (RD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DARNALL
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 1:1525 W HOMER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1280
Mailing Address - Country:US
Mailing Address - Phone:888-785-7370
Mailing Address - Fax:888-785-7380
Practice Address - Street 1:1525 W HOMER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1280
Practice Address - Country:US
Practice Address - Phone:888-785-7370
Practice Address - Fax:888-785-7380
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1088078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered