Active NPI
Maryanna Staerk, MBA, LDN
- Registered Dietitian
- Lake Forest, CA
National Provider Identifier
1174759104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DN008520
- Practice address
- 24531 Via Tonada
Lake Forest, CA 92630-2027 - Phone
- (949) 690-9132
- NPI assigned
- Jun 4, 2009
- Reactivated
- Feb 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DN008520 | PA | Primary |
Addresses
Primary practice location
24531 Via Tonada
Lake Forest, CA 92630-2027
Mailing address
PO Box 5
Kintnersville, PA 18930-0005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN008520 | PA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Greens LLC | Current | Accepting new patients | |
| Inward Bloom PLLC | Dietitian, Registered | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757635200000",
"number": "1174759104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5",
"city": "KINTNERSVILLE",
"state": "PA",
"postal_code": "189300005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24531 VIA TONADA",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926302027",
"telephone_number": "949-690-9132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAERK",
"first_name": "MARYANNA",
"credential": "MBA, LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-04",
"last_updated": "2025-09-12",
"certification_date": "2025-09-12",
"deactivation_date": "2021-04-21",
"reactivation_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "PA",
"license": "DN008520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.