Provider Demographics
NPI:1760151898
Name:NOURISHED RD, LLC
Entity Type:Organization
Organization Name:NOURISHED RD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:BOKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CEDRD
Authorized Official - Phone:240-687-1703
Mailing Address - Street 1:500 OCEAN AVE UNIT 655
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1445
Mailing Address - Country:US
Mailing Address - Phone:240-687-1703
Mailing Address - Fax:
Practice Address - Street 1:399 BOYLSTON ST STE 900
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3305
Practice Address - Country:US
Practice Address - Phone:617-383-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty