Active NPI
Jennifer Waters, R.D, L.D.N
- Registered Dietitian
- Aurora, IL
National Provider Identifier
1992070536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164.004597
- Practice address
- 1638 Fredericksburg LN
Aurora, IL 60503-3674 - Phone
- (847) 293-2480
- NPI assigned
- Mar 15, 2012
- Sex
- Female
- Sole proprietor
- No
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 | 164.004597 | IL | Primary |
Addresses
Primary practice location
1638 Fredericksburg LN
Aurora, IL 60503-3674
Mailing address
1638 Fredericksburg LN
Aurora, IL 60503-3674
Phone (847) 293-2480
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164.004597 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331769600000",
"number": "1992070536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1638 FREDERICKSBURG LN",
"city": "AURORA",
"state": "IL",
"postal_code": "605033674",
"telephone_number": "847-293-2480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 FREDERICKSBURG LN",
"city": "AURORA",
"state": "IL",
"postal_code": "605033674",
"telephone_number": "847-293-2480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "JENNIFER",
"credential": "R.D, L.D.N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-15",
"last_updated": "2012-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164.004597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.