Individual
ALEXANDRA MARIE ISHMAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED DIETITIAN
Contact information
Practice address
319 E MADISON ST STE 1F, SPRINGFIELD, IL 62701-1035
(217) 788-3948
(217) 527-3209
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(800) 577-5368
(217) 757-2021
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164007543
LICENSED DIETITIAN NUTRITIONIST LICENSE
IL
Enumeration date
05/21/2019
Last updated
05/21/2019
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