Modern Nutrition NW LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

MODERN NUTRITION NW LLC

Practice address

7003 SE Yearling LN
Portland, OR 97267-1983

Phone

(503) 650-3801

Fax

(503) 650-7002

NPI assigned

Jan 24, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Krista Suzzanne Schaefer, MS RDN LDNPI 1033392618

Title

Registered Dietitian Nutritionist

Phone

(503) 313-6461

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Krista S Schaefer, MS RDN LD

  • Registered Dietitian
  • Oregon City, OR
  • NPI 1033392618
  Medicare reassignment NPD Authorized official
• Janet G. Mann, RDN

  • Registered Dietitian
  • Oregon City, OR
  • NPI 1770547085
  NPD (past)

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756166400000",
    "number": "1235769670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 493",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970150493",
            "telephone_number": "503-650-3801",
            "fax_number": "503-650-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7003 SE YEARLING LN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972671983",
            "telephone_number": "503-650-3801",
            "fax_number": "503-650-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN NUTRITION NW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-24",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A",
        "authorized_official_last_name": "SCHAEFER",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "SUZZANNE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN NUTRITIONIST",
        "authorized_official_telephone_number": "503-313-6461",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS RDN LD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Craig Mocny, PHARM.D.
• Moda Wellness LLC
• Modagrant
• Modern Eye Care of Portland LLC
• Modern Mindful Psychotherapy
• Autumn Jennifer Modest
• Nir Modiano, MD, PHD
• Rachel Marie Modica-Russell
• John Matthew Tan Modina, PT
• Emily Modlin, BA

• Health Service Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Health Service Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; 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.