Provider Demographics
NPI:1811101637
Name:WILLIAMS, KIM NANCY (MBA, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:NANCY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MBA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 MEADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-6446
Mailing Address - Country:US
Mailing Address - Phone:630-375-0136
Mailing Address - Fax:
Practice Address - Street 1:RUSH COPLEY MEDICAL CENTER
Practice Address - Street 2:2000 OGDEN AVE
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-898-3410
Practice Address - Fax:630-898-3672
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered