Active NPI
Tonya Hagenbaumer, M.S.R.D.L.D.
- Registered Dietitian
- Joliet, IL
National Provider Identifier
1033360136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 806637
- Practice address
- 2025 S. Chicago Street
Joliet, IL 60436 - Phone
- (815) 726-2200
- NPI assigned
- Oct 7, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 806637 | IL | Primary |
Addresses
Primary practice location
2025 S. Chicago Street
Joliet, IL 60436
Mailing address
2025 S Chicago St
Joliet, IL 60436-3172
Phone (815) 726-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164002717 | Other | IL | STATE LICSENCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 806637 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223337600000",
"number": "1033360136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2025 S CHICAGO ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604363172",
"telephone_number": "815-726-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2025 S. CHICAGO STREET",
"city": "JOLIET",
"state": "IL",
"postal_code": "60436",
"telephone_number": "815-726-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGENBAUMER",
"first_name": "TONYA",
"credential": "M.S.R.D.L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-07",
"last_updated": "2008-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "806637",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICSENCE",
"identifier": "164002717",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.