Healthcare Provider Details

I. General information

NPI: 1518835461
Provider Name (Legal Business Name): MISSION NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 HARLEM AVE APT 16
GLENVIEW IL
60025-4279
US

IV. Provider business mailing address

921 HARLEM AVE APT 16
GLENVIEW IL
60025-4279
US

V. Phone/Fax

Practice location:
  • Phone: 224-714-9420
  • Fax:
Mailing address:
  • Phone: 224-714-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANITA VANDERGRAAF
Title or Position: OWNER
Credential: RD
Phone: 224-714-9420