Provider Demographics
NPI:1598149148
Name:ROGAN, TAVIERNEY (RD)
Entity type:Individual
Prefix:
First Name:TAVIERNEY
Middle Name:
Last Name:ROGAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W VAN BUREN ST UNIT 908
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3840
Mailing Address - Country:US
Mailing Address - Phone:847-440-6617
Mailing Address - Fax:
Practice Address - Street 1:808 W VAN BUREN ST UNIT 908
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3840
Practice Address - Country:US
Practice Address - Phone:847-440-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.006522133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered