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General NPI Number Information
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NPI Number | 1518835461
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Entity Type | Organization
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Legal Business Name | MISSION NUTRITION LLC
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 921 HARLEM AVE APT 16
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City | GLENVIEW
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State | IL
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Zip | 60025-4279
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Country | US
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Telephone | 224-714-9420
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Fax |
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Provider Business Mailing Address
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Address Line | 921 HARLEM AVE APT 16
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City | GLENVIEW
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State | IL
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Zip | 60025-4279
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Country | US
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Telephone | 224-714-9420
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANITA VANDERGRAAF
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Credential | RD
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Telephone | 224-714-9420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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