Provider Demographics
NPI:1104194521
Name:GRUSHON, MEGAN NICOLE (RD, LD, CLT)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:NICOLE
Last Name:GRUSHON
Suffix:
Gender:F
Credentials:RD, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2040
Mailing Address - Country:US
Mailing Address - Phone:913-685-3500
Mailing Address - Fax:913-685-4975
Practice Address - Street 1:8900 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2040
Practice Address - Country:US
Practice Address - Phone:913-685-3500
Practice Address - Fax:913-685-4975
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1599133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered