Provider Demographics
NPI:1881462380
Name:HOSTER, DEVON (MS, RD, LDN)
Entity type:Individual
Prefix:MISS
First Name:DEVON
Middle Name:
Last Name:HOSTER
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 DICKENS DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9358
Mailing Address - Country:US
Mailing Address - Phone:815-600-0953
Mailing Address - Fax:
Practice Address - Street 1:10505 DICKENS DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9358
Practice Address - Country:US
Practice Address - Phone:815-600-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered