Basic Information
| Provider Information | |||||||||
| NPI: | 1417312232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAUSAMAN | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | MARIANNA | ||||||||
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| Credential: | RDN, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 W WALNUT ST | ||||||||
| Address2: | GRAHAM HOSPITAL FOOD AND NUTRITION SERVICES | ||||||||
| City: | CANTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096475240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 W WALNUT ST | ||||||||
| Address2: | GRAHAM HOSPITAL FOOD AND NUTRITION SERVICES | ||||||||
| City: | CANTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096475240 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2015 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164.006671 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.