Provider Demographics
NPI:1780401315
Name:SERA, MARGARET (MS, RDN, LDN, CNSC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:SERA
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CNSC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:SERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN, LDN, CNSC
Mailing Address - Street 1:15651 GARDEN VIEW CT APT 3D
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3082
Mailing Address - Country:US
Mailing Address - Phone:708-846-3180
Mailing Address - Fax:
Practice Address - Street 1:15651 GARDEN VIEW CT APT 3D
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3082
Practice Address - Country:US
Practice Address - Phone:708-846-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008811133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered