Individual
KERRY S NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
6303 N CLARK ST, CHICAGO, IL 60660-1203
(773) 270-1652
Mailing address
1707 LAKE AVE, WILMETTE, IL 60091-1537
(312) 330-3358
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164.005078
PRIVATE
IL
Enumeration date
10/19/2021
Last updated
10/19/2021
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