Provider Demographics
NPI:1952900763
Name:WILLIAMS, DANIELLE VICTORIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:VICTORIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LILA LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5406
Mailing Address - Country:US
Mailing Address - Phone:314-599-6313
Mailing Address - Fax:
Practice Address - Street 1:5900 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2326
Practice Address - Country:US
Practice Address - Phone:618-552-5458
Practice Address - Fax:618-332-5369
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046996133V00000X
IL164007995133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164007995OtherLISCENSED DIETITIAN- STATE OF ILLINOIS
86109984OtherACADEMY OF NUTRITION AND DIETETICS REGISTRATION ID NUMBER