Danielle Marianna Larson, RDN, LD | |
1017 Jefferson St, Pekin, IL 61554-1640 | |
(217) 416-3101 | |
Not Available |
Full Name | Danielle Marianna Larson |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 1017 Jefferson St, Pekin, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1417312232 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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133V00000X | Dietitian, Registered | 164.006671 (Illinois) | Primary |
Provider Name | Nourish, Inc. |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1558097824 PECOS PAC ID: 1557724937 Enrollment ID: O20230901000471 |
Mailing Address | Practice Location Address |
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Danielle Marianna Larson, RDN, LD 1017 Jefferson St, Pekin, IL 61554-1640 Ph: (217) 416-3101 | Danielle Marianna Larson, RDN, LD 1017 Jefferson St, Pekin, IL 61554-1640 Ph: (217) 416-3101 |
Mrs. Emmy M Thies, BS, RD, LDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 600 S 13th St, Pekin, IL 61554 Phone: 309-353-0508 Fax: 309-353-0710 | |
Laura Christine Fuelberth, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 2106 Highwood Ave, Pekin, IL 61554 Phone: 630-748-9825 | |
Judy C Getz, RD, BS, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 600 S 13th St, Pekin, IL 61554 Phone: 309-353-0589 Fax: 309-353-0710 |