Healthcare Provider Details

I. General information

NPI: 1295498087
Provider Name (Legal Business Name): NOURISH HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117B MAIN ST STE 3
DOWNERS GROVE IL
60515-4602
US

IV. Provider business mailing address

5117B MAIN ST STE 3
DOWNERS GROVE IL
60515-4602
US

V. Phone/Fax

Practice location:
  • Phone: 630-442-0169
  • Fax: 708-234-7065
Mailing address:
  • Phone: 630-442-0169
  • Fax: 708-234-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ROBINSON
Title or Position: OWNER
Credential: ND, CNS, LDN
Phone: 630-442-0169