Summit Nutrition Services, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

37001987A Issued in IN

Legal business name

SUMMIT NUTRITION SERVICES, LLC

Practice address

3027 Mariposa Place
Fort Wayne, IN 46818

Phone

(260) 487-9983

Fax

(260) 489-5072

NPI assigned

Mar 8, 2010

Organization subpart

No

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

Authorized official

Name

Perpetua Delrine Fernando, PHD, RD, CD

Title

Registered Dietitian

Phone

(260) 487-9983

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268006400000",
    "number": "1295058071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 MARIPOSA PLACE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46818",
            "telephone_number": "260-487-9983",
            "fax_number": "260-489-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3027 MARIPOSA PLACE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46818",
            "telephone_number": "260-487-9983",
            "fax_number": "260-489-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT NUTRITION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-03-08",
        "status": "A",
        "authorized_official_last_name": "FERNANDO",
        "authorized_official_first_name": "PERPETUA",
        "authorized_official_middle_name": "DELRINE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "260-487-9983",
        "authorized_official_credential": "PHD, RD, CD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "37001987A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summit City Smiles
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• Summit Physical Therapy LLC
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• Summit Radiology P C

• Registered Dietitian in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; 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.