| Doctor Name: | MRS. ILENE TERRI WYNN |
| NPI Number: | 1063533602 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D., L.D.N. |
| License Number: | |
| Business Practice Address: | 1560 Sherman Ave Suite #400 Evanston, IL - 602014818 |
| Business Phone Number: | 8478691500 |
| Business Fax Number: | 8478691515 |
| Mailing Address: | 2246 Avalon Dr, BUFFALO GROVE |
| State: | IL |
| Postal Code: | 600894682 |
| Phone Number: | 8479131652 |
| Fax Number: | 8479131758 |
| NPI Enumeration Date: | 04/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |