Healthcare Provider Details

I. General information

NPI: 1780514430
Provider Name (Legal Business Name): NUTRITION FAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15811 CENTRAL AVE UNIT 3
OAK FOREST IL
60452-7601
US

IV. Provider business mailing address

15811 CENTRAL AVE UNIT 3
OAK FOREST IL
60452-7601
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-8188
  • Fax:
Mailing address:
  • Phone: 708-209-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA ANDRIACCHI
Title or Position: NUTRITIONIST
Credential: MSN, CNS, LDN
Phone: 708-209-8188