Individual provider · NPI-1

Ellen C Homann, M.S, R.D., L.D.N

Dietitian, Registered · Mattoon, IL

NPI number1316242233
StatusActive
Last updated in NPPESJan 25, 2011

Details

NPI
1316242233
Entity type
Individual (NPI-1)
Name
Ellen C Homann
Credential
M.S, R.D., L.D.N
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 25, 2011
Last updated
Jan 25, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered164.004542ILYes

Other names

  • Ellen C Shike (Former Name)

Practice location

501 Lake Land Blvd
Suite D
Mattoon, IL 61938-5283

Phone 217-258-3370 · Fax 217-258-3379

Mailing address

501 Lake Land Blvd
Suite D
Mattoon, IL 61938-5283

Phone 217-258-3370 · Fax 217-258-3379

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