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Individual
VICKIE MARIE
Active
Individual
VICKIE MARIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RD, LDN
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164003006
IL
133V00000X
Registered Dietitian
37001171A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001633301
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/30/2007
Last updated
12/29/2010
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