Doctor Name: | MRS. MARILYN BUKOFF PRIDDY |
NPI Number: | 1285078931 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, RD, LDN |
License Number: | 164.001446 |
Business Practice Address: | 1617 W Devereux Dr Peoria, IL - 616144009 |
Business Phone Number: | 3096938128 |
Business Fax Number: | |
Mailing Address: | 1617 Devereux Dr, PEORIA |
State: | IL |
Postal Code: | 616144009 |
Phone Number: | 3096938128 |
Fax Number: | |
NPI Enumeration Date: | 04/24/2013 |
NPI Last Update Date: | 04/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 164.001446 |
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 |