Provider Demographics
NPI:1457336414
Name:PARIS, ERIN M (RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:PARIS
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 1:1613 CRESSA CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3279
Mailing Address - Country:US
Mailing Address - Phone:217-622-5223
Mailing Address - Fax:217-726-0300
Practice Address - Street 1:1613 CRESSA CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3279
Practice Address - Country:US
Practice Address - Phone:217-622-5223
Practice Address - Fax:217-726-0300
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1501X
IL164-003845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q60285Medicare UPIN
IL256510Medicare PIN
IL256510025Medicare PIN