Basic Information
| Provider Information | |||||||||
| NPI: | 1417378340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRURY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12385 DAIBER RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622495902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183630188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2013 | ||||||||
| LastUpdateDate: | 12/19/2013 | ||||||||
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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 | 164.003554 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | 2001003454 | MO | N | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.