Ishmael, Alexandra Marie

Ishmael, Alexandra Marie is an individual health care provider with primary practice located at 319 E Madison St Ste 1F , Springfield IL 62701-1035. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Ishmael, Alexandra Marie can be contacted via phone (217) 788-3948.

Contact Information

Primary practice address
319 E Madison St Ste 1F Springfield IL 62701-1035
Phone: (217) 788-3948
Fax: (217) 527-3209
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X

Profile Details

NPI number 1265099758
LBN Legal business name Ishmael, Alexandra Marie
Credentials LICENSED DIETITIAN
Entity Individual
Sole proprietor 1 No
Enumeration date May 21st, 2019
Last updated May 21st, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265099758 NPPES
Illinois Other 164007543 LICENSED DIETITIAN NUTRITIONIST LICENSE

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