Provider Demographics
NPI:1801522578
Name:HOSKINS, CHARLENE LYNETTE (RD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:LYNETTE
Last Name:HOSKINS
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 1:5803 N CYPRESS DR APT 3001
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-8410
Mailing Address - Country:US
Mailing Address - Phone:217-918-1823
Mailing Address - Fax:
Practice Address - Street 1:5401 N KNOXVILLE AVE STE 104
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5021
Practice Address - Country:US
Practice Address - Phone:309-643-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered