Active NPI
Great Basin Nutrition LLC
- Registered Dietitian
- Carson City, NV
National Provider Identifier
1053883520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Legal business name
- GREAT BASIN NUTRITION LLC
- Practice address
- 783 Basque Way Ste 103
Carson City, NV 89706-7981 - Phone
- (775) 720-3490
- Fax
- (775) 245-2867
- NPI assigned
- Dec 21, 2018
- Last updated
- Dec 21, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jodi Pettersen, RDN, LD
- Title
- Owner
- Phone
- (775) 720-3490
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
783 Basque Way Ste 103
Carson City, NV 89706-7981
Mailing address
783 Basque Way Ste 103
Carson City, NV 89706-7981
Phone (775) 720-3490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
783 Basque Way
Ste 103
Carson City, NV 89706
Phone (775) 720-3490
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545350400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1545350400000",
"number": "1053883520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "783 BASQUE WAY STE 103",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897067981",
"telephone_number": "775-720-3490",
"fax_number": "775-245-2867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "783 BASQUE WAY STE 103",
"city": "CARSON CITY",
"state": "NV",
"postal_code": "897067981",
"telephone_number": "775-720-3490",
"fax_number": "775-245-2867"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GREAT BASIN NUTRITION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-12-21",
"last_updated": "2018-12-21",
"status": "A",
"authorized_official_last_name": "PETTERSEN",
"authorized_official_first_name": "JODI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "775-720-3490",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RDN, LD"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carson City, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.