Provider Demographics
NPI:1740639830
Name:FAYCURRY, RITA (RD, LDN)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:FAYCURRY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3282
Mailing Address - Country:US
Mailing Address - Phone:630-635-5950
Mailing Address - Fax:
Practice Address - Street 1:113 SOUTH MONROE STREET FIRST FLOOR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5834
Practice Address - Country:US
Practice Address - Phone:630-635-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered