Provider Demographics
NPI:1952063885
Name:SCHUBERT, ANN MARIE (LDN)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:O'DWGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 S YORK ST STE 1240
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5627
Mailing Address - Country:US
Mailing Address - Phone:331-221-6140
Mailing Address - Fax:331-221-3838
Practice Address - Street 1:1200 S YORK ST STE 1240
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5627
Practice Address - Country:US
Practice Address - Phone:331-221-6140
Practice Address - Fax:331-221-3838
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002773133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered