Provider Demographics
NPI:1174291223
Name:HEALTHY RISE NUTRITION
Entity Type:Organization
Organization Name:HEALTHY RISE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GANNON
Authorized Official - Last Name:KAUFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:319-423-7090
Mailing Address - Street 1:227 GREENFIELD ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1626
Mailing Address - Country:US
Mailing Address - Phone:319-431-8764
Mailing Address - Fax:
Practice Address - Street 1:227 GREENFIELD ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1626
Practice Address - Country:US
Practice Address - Phone:319-431-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty