Provider Demographics
NPI:1669703666
Name:MONU, PRISCILLA NWAMY (MS,RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:NWAMY
Last Name:MONU
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:MRS
Other - First Name:PRISCILLA
Other - Middle Name:NWAMU
Other - Last Name:MONU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,RD,LDN
Mailing Address - Street 1:2924 W 83RD ST
Mailing Address - Street 2:2924 W 83RD ST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3404
Mailing Address - Country:US
Mailing Address - Phone:773-995-6300
Mailing Address - Fax:773-995-6179
Practice Address - Street 1:1029 E 130TH ST
Practice Address - Street 2:1029 E 130TH ST
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6908
Practice Address - Country:US
Practice Address - Phone:773-995-6300
Practice Address - Fax:773-995-6179
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004009133N00000X, 133V00000X, 133VN1004X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic