Paula K Celani, RD, LDN

Individual provider Active NPI Registered Dietitian · Blue Island, IL

NPI 1144597360 · NPPES record last updated Nov 17, 2011

Key facts

NPI
1144597360
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
164.002279 (IL)
Practice address
12935 Gregory St
Blue Island, IL 60406-2428
Phone
(708) 824-4659
NPI assigned
Nov 17, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
164L002279ILMDNutritionist
164.002279ILMDRenal Nutrition Registered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nutritionist 133N00000X 164L002279 IL
Nutrition Education Nutritionist 133NN1002X 164.002279 IL
Registered Dietitian 133V00000X 164.002279 IL Yes
Pediatric Nutrition Registered Dietitian 133VN1004X 164.002279 IL
Renal Nutrition Registered Dietitian 133VN1005X 164.002279 IL
Metabolic Nutrition Registered Dietitian 133VN1006X 164.002279 IL

Addresses

Primary practice location

12935 Gregory St
Blue Island, IL 60406-2428

Mailing address

14417 S 90TH CT
Orland Park, IL 60462-6213
Phone (708) 873-0103

Other providers in Blue Island, IL

All providers in Blue Island, IL · Registered Dietitian in Illinois

Sources for this page

Verify at the official NPI Registry.