NPI 1104306240 · live from the CMS NPI Registry
A New Leaf Natural Medicine LLC
Dietitian, Registered in Evanston, IL. National Provider Identifier 1104306240, active.
NPI record
| NPI | 1104306240 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 708 Church St, Evanston, IL 60201 |
| Practice phone | 847-903-0503 |
| Mailing address | 1420 W Hutchinson St Apt 3n, Chicago, IL 60613 |
| Enumerated | August 17, 2018 |
| Last updated | October 10, 2020 |
| Authorized official | Bonnie Brock, Sole Member |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 1640006979 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.