Pro Lifestyle Nutrition

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DN004844 Issued in PA

Legal business name

PRO LIFESTYLE NUTRITION

Practice address

405 Lodges LN
Elkins Park, PA 19027-2506

Phone

(215) 264-2574

NPI assigned

Nov 12, 2012

Last updated

Aug 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Rachel A Hudes, M.S., R.D., L.D.N.NPI 1063779791

Title

Owner/Director

Phone

(215) 264-2574

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rachel Hudes, RD

  • Registered Dietitian
  • Elkins Park, PA
  • NPI 1063779791

  Dietitian, Registered

  NPD (past) Authorized official

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

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439424000000",
    "number": "1255675468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 LODGES LN",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272506",
            "telephone_number": "215-264-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 LODGES LN",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272506",
            "telephone_number": "215-264-2574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO LIFESTYLE NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-12",
        "last_updated": "2015-08-13",
        "status": "A",
        "authorized_official_last_name": "HUDES",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "215-264-2574",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S., R.D., L.D.N."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN004844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1063779791",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; 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.