Active NPI
Lily Beth Wawrzon, RD, LDN
- Registered Dietitian
- Oak Park, IL
National Provider Identifier
1073336798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.011098
- Practice address
- 965 Lake St
Oak Park, IL 60301-1292 - Phone
- (708) 902-4522
- NPI assigned
- Nov 1, 2024
- 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 | 164.011098 | IL | Primary |
Addresses
Primary practice location
965 Lake St
Oak Park, IL 60301-1292
Mailing address
965 Lake St
Oak Park, IL 60301-1292
Phone (708) 902-4522
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.011098 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nutriquity, LLC | Dietitian, Registered | Past | Accepting new patients |
| Nutriquity Nwi LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730419200000",
"number": "1073336798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "965 LAKE ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011292",
"telephone_number": "708-902-4522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 LAKE ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603011292",
"telephone_number": "708-902-4522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAWRZON",
"first_name": "LILY",
"middle_name": "BETH",
"name_prefix": "Miss",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-01",
"last_updated": "2024-11-01",
"certification_date": "2024-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.011098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.