Provider Demographics
NPI:1184278640
Name:DIPIETRO, MARY BELLUOMINI (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BELLUOMINI
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CHRISTINE
Other - Last Name:BELLUOMINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1000 NORTH WESTMORELAND RD.
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:224-271-5520
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTH WESTMORELAND RD.
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:224-271-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86029256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered