Provider Demographics
NPI:1982709515
Name:CZERNECKI, DEBORAH (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:CZERNECKI
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 1:9126 PHILANDER CHASE LN
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-9488
Mailing Address - Country:US
Mailing Address - Phone:309-446-9606
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:800-320-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
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