Organization
A NEW LEAF NATURAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONNIE LYNN BROCK MPH, RD, LDN, ND (SOLE MEMBER)
(847) 903-0503
Entity
Organization
Contact information
Practice address
708 CHURCH ST, EVANSTON, IL 60201-3875
(847) 903-0503
Mailing address
1420 W HUTCHINSON ST APT 3N, CHICAGO, IL 60613-1343
(773) 331-1740
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1640006979
IL
Other
Enumeration date
08/17/2018
Last updated
10/10/2020
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