Provider Demographics
NPI:1295252880
Name:PAUL, DANA (RD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:DUMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2923 CORNWALL LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4659
Mailing Address - Country:US
Mailing Address - Phone:630-441-6713
Mailing Address - Fax:
Practice Address - Street 1:800 E WOODFIELD RD STE 113
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4786
Practice Address - Country:US
Practice Address - Phone:847-686-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL926139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered