Organization
AUTHENTIC HEALTH NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY LYONS RD (OWNER OF BUSINESS)
(217) 552-2851
Entity
Organization
Contact information
Practice address
1506 BLUEGRASS LN, CHAMPAIGN, IL 61822-2075
(217) 552-2851
Mailing address
1506 BLUEGRASS LN, CHAMPAIGN, IL 61822-2075
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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