Organization
REBEL NUTRITION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REANNA PETERMAN MS, RDN, LDN (MANAGER)
(815) 409-8501
Entity
Organization
Contact information
Practice address
1919 W TAYLOR ST, CHICAGO, IL 60612-7246
(815) 409-8501
Mailing address
831 CEDAR CIR, MANTENO, IL 60950-1820
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/19/2024
Last updated
04/28/2025
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