Nutrastead & Co
Organization Active NPI Registered Dietitian · Dewitt, IL
NPI 1104497189 · NPPES record last updated Jul 9, 2021
Key facts
- NPI
- 1104497189
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Registered Dietitian 133V00000X
- Legal business name
- NUTRASTEAD & CO
- Practice address
- 12764 Solomon Rd
Dewitt, IL 61735-9448 - Phone
- (217) 520-3209
- NPI assigned
- Jul 9, 2021
- Organization subpart
- No
Authorized official
- Name
- Moriah Gramm, MS, RD, LDN
- Title
- Registered Dietitian
- Phone
- (217) 520-3209
Practitioners 1
-
Moriah Gramm, MS, RD, LDN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220414001016 | IL | Part B Supplier - Clinic/Group Practice | 9638565930 |
Receives reassigned benefits from 1 practitioner Practice locations: Bloomington, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | Yes |
Addresses
Primary practice location
12764 Solomon Rd
Dewitt, IL 61735-9448
Mailing address
12764 Solomon Rd
Dewitt, IL 61735-9448
Phone (217) 520-3209
Other providers in Dewitt, IL
All providers in Dewitt, IL · Registered Dietitian in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.