Provider Demographics
NPI:1801657390
Name:PRISECARU, VALENTIN ION (MS, CN, LDN)
Entity type:Individual
Prefix:
First Name:VALENTIN
Middle Name:ION
Last Name:PRISECARU
Suffix:
Gender:M
Credentials:MS, CN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61924-1209
Mailing Address - Country:US
Mailing Address - Phone:217-714-6020
Mailing Address - Fax:
Practice Address - Street 1:301 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:CHRISMAN
Practice Address - State:IL
Practice Address - Zip Code:61924-1209
Practice Address - Country:US
Practice Address - Phone:217-714-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.009534133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist