A New Leaf Natural Medicine LLC
Organization Active NPI Registered Dietitian · Evanston, IL
NPI 1104306240 · NPPES record last updated Oct 10, 2020
Key facts
- NPI
- 1104306240
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 1640006979 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Bonnie Lynn Brock, MPH, RD, LDN, ND
- Title
- Sole Member
- Phone
- (847) 903-0503
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | 1640006979 | IL | Yes |
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
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.