Individual
REBECCA A ANTONACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
415 N 9TH ST, STE 6W162, SPRINGFIELD, IL 62702-5303
(217) 545-3848
(217) 545-4912
Mailing address
PO BOX 19640, SPRINGFIELD, IL 62794-9640
(217) 545-3848
(217) 545-4912
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
164-002929
IL
133V00000X
Registered Dietitian
164002929
IL
Other
Enumeration date
11/08/2005
Last updated
03/18/2010
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