NPIMap

Organization Active NPI

Gentree Nutrition

  • Nutritionist
  • Park Forest, IL
National Provider Identifier
1073228243
Registry record updated Jan 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
NutritionistTaxonomy code 133N00000X
Legal business name
GENTREE NUTRITION
Practice address
20 Forest Blvd
Park Forest, IL 60466-1753
Phone
(630) 890-3081
NPI assigned
Jan 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teri BroadnaxNPI 1447964499
Title
Licensed Dietitian Nutritionist
Phone
(708) 897-1612

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
NutritionistGroup: 193400000X SINGLE SPECIALTY GROUP 133N00000X Primary

Addresses

Primary practice location

20 Forest Blvd
Park Forest, IL 60466-1753

Mailing address

20 Forest Blvd
Park Forest, IL 60466-1753
Phone (708) 897-1612

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767312000000",
    "number": "1073228243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 FOREST BLVD",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661753",
            "telephone_number": "708-897-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 FOREST BLVD",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604661753",
            "telephone_number": "630-890-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENTREE NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-20",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A",
        "authorized_official_last_name": "BROADNAX",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "LICENSED DIETITIAN NUTRITIONIST",
        "authorized_official_telephone_number": "708-897-1612"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.