Provider Demographics
NPI:1629890066
Name:REAL. HONEST. NUTRITION. LLC
Entity type:Organization
Organization Name:REAL. HONEST. NUTRITION. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAVIERNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, RDN
Authorized Official - Phone:847-440-6617
Mailing Address - Street 1:808 W VAN BUREN ST UNIT 908
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3840
Mailing Address - Country:US
Mailing Address - Phone:847-440-6617
Mailing Address - Fax:
Practice Address - Street 1:808 W VAN BUREN ST UNIT 908
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3840
Practice Address - Country:US
Practice Address - Phone:847-440-6617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty