Active NPI
Nicole L Tracy, RD, LDN
- Pediatric Nutrition Registered Dietitian
- Naperville, IL
National Provider Identifier
1154448199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- License
- 164.002997
- Practice address
- 1004 Churchill Dr
Naperville, IL 60563-2081 - Phone
- (630) 776-1766
- Fax
- (630) 548-5274
- NPI assigned
- Mar 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | 164.002997 | IL | Primary |
Addresses
Primary practice location
1004 Churchill Dr
Naperville, IL 60563-2081
Mailing address
1004 Churchill Dr
Naperville, IL 60563-2081
Phone (630) 776-1766
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 |
|---|---|---|---|
| 164.002997 | IL | MD | Pediatric Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297814400000",
"number": "1154448199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 CHURCHILL DR",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605632081",
"telephone_number": "630-776-1766",
"fax_number": "630-548-5274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 CHURCHILL DR",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605632081",
"telephone_number": "630-776-1766",
"fax_number": "630-548-5274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "NICOLE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "RD, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-23",
"last_updated": "2011-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "IL",
"license": "164.002997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.