Provider Demographics
NPI:1417436551
Name:NEVA, KIMBERLY MAE (MS, RD, CSOWM, LDN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAE
Last Name:NEVA
Suffix:
Gender:F
Credentials:MS, RD, CSOWM, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 818
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3895
Mailing Address - Country:US
Mailing Address - Phone:213-942-4444
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 818
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3895
Practice Address - Country:US
Practice Address - Phone:213-942-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered