Active NPI
Nicolette Durkin
- Registered Dietitian
- Shorewood, IL
National Provider Identifier
1174337901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164006888
- Practice address
- 1120 Ranchwood Dr
Shorewood, IL 60404-9127 - Phone
- (815) 355-5079
- NPI assigned
- Feb 3, 2025
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164006888 | IL | Primary |
Addresses
Primary practice location
1120 Ranchwood Dr
Shorewood, IL 60404-9127
Mailing address
1120 Ranchwood Dr
Shorewood, IL 60404-9127
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 |
|---|---|---|---|
| 164006888 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1174337901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 RANCHWOOD DR",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604049127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 RANCHWOOD DR",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604049127",
"telephone_number": "815-355-5079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURKIN",
"first_name": "NICOLETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-02-03",
"last_updated": "2025-02-03",
"certification_date": "2025-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164006888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.