Individual
MRS. HEATHER SUE ILLG
Active
Individual
MRS. HEATHER SUE ILLG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LD
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
01342
IA
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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