Provider Demographics
NPI:1457367500
Name:ZWART, CINDY-LU (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:CINDY-LU
Middle Name:
Last Name:ZWART
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W. NORTH AVENUE, EDM CONSULTANT SERVICES LTD,
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1622
Mailing Address - Country:US
Mailing Address - Phone:708-681-7695
Mailing Address - Fax:
Practice Address - Street 1:675 W. NORTH AVENUE, EDM CONSULTANT SERVICES LTD,
Practice Address - Street 2:SUITE 104
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1622
Practice Address - Country:US
Practice Address - Phone:708-681-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001251133V00000X
136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00049Medicare PIN