Provider Demographics
NPI:1013252501
Name:D'AMICO, EILEEN RYAN (MS, RD, LDN, CNSC)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:RYAN
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:MS, RD, LDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 N SOUTHPORT AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1229
Mailing Address - Country:US
Mailing Address - Phone:312-208-6353
Mailing Address - Fax:
Practice Address - Street 1:2737 N SOUTHPORT AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1229
Practice Address - Country:US
Practice Address - Phone:312-208-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered