Mary Condon, RD, LDN
Individual provider Active NPI Registered Dietitian · Flossmoor, IL
NPI 1417436767 · NPPES record last updated Aug 8, 2018
Key facts
- NPI
- 1417436767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 164006369 (IL)
- Practice address
- 19550 Governors Hwy Ste 2400
Flossmoor, IL 60422-2144 - Phone
- (708) 915-8850
- Fax
- (708) 915-8586
- NPI assigned
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164006369 | IL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maine Coast Regional Health Facilities | Current |
Accepting new patients | |
| Maine Coast Regional Health Facilities | Current |
Accepting new patients |
Locations
50 Union St
Ellsworth, ME 04605
Phone (207) 664-5304
32 Resort Way
Ellsworth, ME 04605
Phone (207) 664-5480
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164006369 | IL | Yes |
Addresses
Primary practice location
19550 Governors Hwy Ste 2400
Flossmoor, IL 60422-2144
Mailing address
19550 Governors Hwy Ste 2400
Flossmoor, IL 60422-2144
Phone (708) 915-8850
Other providers in Flossmoor, IL
- Collabcore
- Melinda A Collins
- Sandra K. Collins
- Sean Collins
- Community Wellness Group LLC
- Tiffinie Conner
- Ghana Marie Cooper
- Counseling Healing and Restoring the Inner Self to Mindful Authenticit
- Kimberly Coupet
- Covenant Med Devices and Supplies, Inc.
All providers in Flossmoor, IL · Registered Dietitian in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.