Healthenutrifit LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

HEALTHENUTRIFIT LLC

Practice address

750 Main St
Suite 100
Mendota Heights, MN 55118-3764

Phone

(651) 592-7830

Fax

(651) 405-3850

NPI assigned

Feb 22, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Susan Marianne Parks, RD, CSSD,LN

Title

Ceo/Licensed Rd

Phone

(651) 592-7830

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1203638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1225207343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2282 FIELD STONE DRIVE",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201918",
            "telephone_number": "651-592-7830",
            "fax_number": "651-405-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MAIN ST",
            "address_2": "SUITE 100",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551183764",
            "telephone_number": "651-592-7830",
            "fax_number": "651-405-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHENUTRIFIT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-22",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "MARIANNE",
        "authorized_official_title_or_position": "CEO/LICENSED RD",
        "authorized_official_telephone_number": "651-592-7830",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RD, CSSD,LN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "400A2PA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "491211000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Mendota Heights, MN
• Providers in Mendota Heights, MN by specialty
• Registered Dietitian in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.