Provider Demographics
NPI:1831919455
Name:NOURISHED RD PLLC
Entity type:Organization
Organization Name:NOURISHED RD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:480-532-5980
Mailing Address - Street 1:1310 S WAYFARER
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6239
Mailing Address - Country:US
Mailing Address - Phone:480-464-1959
Mailing Address - Fax:
Practice Address - Street 1:1310 S WAYFARER
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6239
Practice Address - Country:US
Practice Address - Phone:480-464-1959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty