NPIMap

Organization Active NPI

A New Leaf Natural Medicine LLC

  • Registered Dietitian
  • Evanston, IL
National Provider Identifier
1104306240
Registry record updated Oct 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1640006979 Issued in IL
Legal business name
A NEW LEAF NATURAL MEDICINE LLC
Practice address
708 Church St
Evanston, IL 60201-3875
Phone
(847) 903-0503
NPI assigned
Aug 17, 2018
Last updated
Oct 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2020

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

Authorized official

Name
Dr. Bonnie Lynn Brock, MPH, RD, LDN, NDNPI 1285171504
Title
Sole Member
Phone
(847) 903-0503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1640006979 IL Primary

Addresses

Primary practice location

708 Church St
Evanston, IL 60201-3875

Mailing address

1420 W Hutchinson St Apt 3N
Chicago, IL 60613-1343
Phone (773) 331-1740

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602288000000",
    "number": "1104306240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 W HUTCHINSON ST APT 3N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131343",
            "telephone_number": "773-331-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 CHURCH ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013875",
            "telephone_number": "847-903-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A NEW LEAF NATURAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-17",
        "last_updated": "2020-10-10",
        "certification_date": "2020-10-10",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "847-903-0503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MPH, RD, LDN, ND"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "1640006979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2020; 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.