NOURISHED LIVING LLC (NPI# 1942817580) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942817580 |
| Entity Type | Organization |
| Organization Name | NOURISHED LIVING LLC |
| Practice Address |
22811 Greater Mack Ave Ste 210 Saint Clair Shores MI 48080-2054 |
| Mailing Address |
676 Canterbury Rd Grosse Pointe Woods MI 48236-1278 |
| Practice Telephone | 2482882680 |
| Mailing Telephone | 3132882680 |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |
| Authorized Official Name | MRS. BETHANY A MATUS (OWNER) |
| Authorized Official Telephone | 3132882680 |
| Authorized Official Credential | RD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | Dietary & Nutritional Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | NOURISHED LIVING LLC | 1716 Central St Ne, Olympia, WA 98506 |
| New York State Corporations | NOURISHED LIVING LLC | 79 Smith Street, Sayville, New York 11782 |
| Street Address |
22811 GREATER MACK AVE STE 210 |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48080-2054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508482084 | Farrah Aleema Rajab | Family Medicine | 24911 Little Mack Avenue, Suite C, St. Clair Shores, MI 48080 | 2020-06-22 |
| 1558986141 | Julia Anastazja Krakowska | Family Medicine | 24911 Little Mack, Suite C, St. Clair Shores, MI 48080 | 2020-06-10 |
| 1972073567 | Joyce Stepnak | Social Worker | 19611 E. 8 Mile Rd, Scs, MI 48080 | 2018-11-27 |
| 1487134177 | Bonnie Girson | Social Worker | 23409 Jefferson Ave Ste 100, Saint Clair Shores, MI 48080 | 2018-08-21 |
| 1609309913 | Park Pharmacy Scs LLC | Pharmacy | 20225 E 9 Mile Rd Ste 120a, Saint Clair Shores, MI 48080 | 2017-04-05 |
| 1730564055 | Mary Rose Giroux | Psychologist | 22516 Overlake St, St. Clair Shores, MI 48080 | 2015-07-28 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1497156228 | Kelly Zalewski | Social Worker | 24631 Jefferson Ave, Saint Clair Shores, MI 48080 | 2014-09-11 |
| 1669871364 | Mallory Margret Gordon | Psychologist | 19900 E. 10 Mile Rd., Ste. 102, Saint Clair Shores, MI 48080 | 2014-08-19 |
| 1932549375 | Alexander Peter Bill | Otolaryngology | 22631 Greater Mack Ave Ste 200, Saint Clair Shores, MI 48080 | 2013-06-30 |
| Find all providers in zip 48080 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760876262 | Natalie Raymond | Dietitian, Registered | 25631 Little Mack Ave # Ll, Saint Clair Shores, MI 48081-2100 | 2015-03-23 |
| 1801901392 | Roxolana Karanecrh | Dietitian, Registered | 22300 Bon Brae St, Saint Clair Shores, MI 48081-2236 | 2006-08-21 |
| 1285080697 | Amanda Alame | Dietitian, Registered | 29519 Harper Ave, Saint Clair Shores, MI 48081-1275 | 2016-05-04 |
| 1346401569 | Shelly Dimovski | Dietitian, Registered | 21400 E 11 Mile Rd, Saint Clair Shores, MI 48081-1502 | 2008-06-20 |
| 1205973120 | Josephine Carlesimo | Dietitian, Registered | 19699 E 8 Mile Rd, Saint Clair Shores, MI 48080-1655 | 2007-01-31 |
| 1740395243 | Denise Manos | Dietitian, Registered | 22300 Bon Brae St, Saint Clair Shores, MI 48081-2236 | 2006-08-21 |
| 1164453114 | Susanne E Consiglio | Dietitian, Registered | 22811 Greater Mack Ave, Suite 105, Saint Clair Shores, MI 48080-2021 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447850011 | Timothy Matthews | Dietitian, Registered | 5057 Jeddo Rd, Grant Township, MI 48032-1402 | 2020-10-31 |
| 1548860075 | Mona Alaudhi | Dietitian, Registered | 3280 Washtenaw Ave Ste B, Ann Arbor, MI 48104-4283 | 2020-10-26 |
| 1497354823 | Carrie Elizabeth Couretas | Dietitian, Registered | 469 W Baker Ave, Clawson, MI 48017-1535 | 2020-10-17 |
| 1881292506 | Meghan Kathleen Pendleton | Dietitian, Registered | 26025 Pillsbury St, Farmington Hills, MI 48334-4345 | 2020-10-14 |
| 1861090771 | Stephanie Spence | Dietitian, Registered | 5629 Summer Ridge Ct Apt F, Kalamazoo, MI 49009-1058 | 2020-10-13 |
| 1902404908 | Christine L Lauer | Dietitian, Registered | 24 Coral Dr Ne, Rockford, MI 49341-8514 | 2020-10-12 |
| 1598372831 | Ann Christine Whetstone | Dietitian, Registered | 1731 Barrington Pl, Ann Arbor, MI 48103-5606 | 2020-09-30 |
| 1396352225 | Elizabeth Ferrall Consulting LLC | Dietitian, Registered | 10200 17 Mile Rd, Marshall, MI 49068-9797 | 2020-09-24 |
| 1720694086 | Kelly Wilson | Dietitian, Registered | 6865 Hitchingham Rd, Ypsilanti, MI 48197-8998 | 2020-09-21 |
| 1154937753 | Colleen Wojdyla | Dietitian, Registered | 31424 Iroquois Dr, Warren, MI 48088-7009 | 2020-09-18 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48080 |
Please comment or provide details below to improve the information on NOURISHED LIVING LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.