Individual provider Active NPI

Laura Jean Zervos, RDN

  • Registered Dietitian
  • Bethel Park, PA
National Provider Identifier
1063997138
Registry record updated Sep 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN006509 Issued in PA
Practice address
5417 Enterprise Blvd
Bethel Park, PA 15102-2691
Phone
(412) 287-5679
NPI assigned
Sep 25, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education Nutritionist 133NN1002X DN006509 PA
Pediatric Nutrition Registered Dietitian 133VN1004X DN006509 PA
Metabolic Nutrition Registered Dietitian 133VN1006X DN006509 PA
Registered Dietitian 133V00000X DN006509 PA Primary

Addresses

Primary practice location

5417 Enterprise Blvd
Bethel Park, PA 15102-2691

Mailing address

5417 Enterprise Blvd
Bethel Park, PA 15102-2691
Phone (412) 287-5679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190122002645 PA Practitioner - Registered Dietitian Or Nutrition Professional 6103163605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN006509PAMDPediatric Nutrition Registered Dietitian

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1063997138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5417 ENTERPRISE BLVD",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151022691",
            "telephone_number": "412-287-5679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5417 ENTERPRISE BLVD",
            "city": "BETHEL PARK",
            "state": "PA",
            "postal_code": "151022691",
            "telephone_number": "412-287-5679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZERVOS",
        "first_name": "LAURA",
        "middle_name": "JEAN",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PA",
            "license": "DN006509",
            "primary": false
        },
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "PA",
            "license": "DN006509",
            "primary": false
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "PA",
            "license": "DN006509",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethel Park, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.

Verify at the official NPI Registry.