Provider Demographics
NPI:1578301826
Name:PEACE, MUNIRIH (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:MUNIRIH
Middle Name:
Last Name:PEACE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S OAK PARK AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3245
Mailing Address - Country:US
Mailing Address - Phone:928-205-7475
Mailing Address - Fax:
Practice Address - Street 1:224 S OAK PARK AVE APT 2D
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3245
Practice Address - Country:US
Practice Address - Phone:928-205-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.009305133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered