Active NPI
Andrea Nichole Raynor, MS, RDN. LDN
- Registered Dietitian
- Chicago, IL
National Provider Identifier
1194541284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- L007541
- Practice address
- 1163 N State St
Chicago, IL 60610-2722 - Phone
- (336) 287-6449
- NPI assigned
- Nov 23, 2024
- 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 | L007541 | NC | Primary |
Addresses
Primary practice location
1163 N State St
Chicago, IL 60610-2722
Mailing address
1163 N State St
Chicago, IL 60610-2722
Phone (336) 287-6449
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L007541 | NC | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LG Nutrition LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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": "1732320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732320000000",
"number": "1194541284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1163 N STATE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606102722",
"telephone_number": "336-287-6449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1163 N STATE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606102722",
"telephone_number": "336-287-6449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYNOR",
"first_name": "ANDREA",
"middle_name": "NICHOLE",
"credential": "MS, RDN. LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-23",
"last_updated": "2024-11-23",
"certification_date": "2024-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "L007541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.