Provider Demographics
NPI:1740906858
Name:ROMERO, REBECCA (LDN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ZACHWIEJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDN
Mailing Address - Street 1:1960 N LINCOLN PARK W APT 1804
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5444
Mailing Address - Country:US
Mailing Address - Phone:224-623-3356
Mailing Address - Fax:
Practice Address - Street 1:1901 N CLYBOURN AVE # C301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5090
Practice Address - Country:US
Practice Address - Phone:773-472-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008819133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CNS18311OtherAMERICAN NUTRITION ASSOCIATION
IL164008819OtherSTATE OF ILLINOIS