Provider Demographics
NPI:1891280566
Name:CHAVES, LAUREN LYNN (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:LYNN
Last Name:CHAVES
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S MILLER ST APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2493
Mailing Address - Country:US
Mailing Address - Phone:330-240-7062
Mailing Address - Fax:
Practice Address - Street 1:560 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1678
Practice Address - Country:US
Practice Address - Phone:773-524-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered