Doctor Name: | MRS. MONIQUE ROBERTSON SPENCER |
NPI Number: | 1265687735 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 164.004111 |
Business Practice Address: | 1526 Manchester Dr Shiloh, IL - 622697278 |
Business Phone Number: | 6186288426 |
Business Fax Number: | |
Mailing Address: | 1526 Manchester Dr, SHILOH |
State: | IL |
Postal Code: | 622697278 |
Phone Number: | 6186288426 |
Fax Number: | |
NPI Enumeration Date: | 11/24/2008 |
NPI Last Update Date: | 11/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1005X |
License Number: | 164.004111 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Renal |
Taxonomy Definition: |