Grand Traverse Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

GRAND TRAVERSE NUTRITION, LLC

Practice address

800 Cottageview Dr
Suite 1076
Traverse City, MI 49684-2616

Phone

(231) 632-1522

NPI assigned

Feb 27, 2014

Last updated

Feb 27, 2014By 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. Miranda Monroe, RDN

Title

Member/Owner

Phone

(231) 632-1522

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1393459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393459200000",
    "number": "1396160388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6263",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496966263",
            "telephone_number": "231-632-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 COTTAGEVIEW DR",
            "address_2": "SUITE 1076",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842616",
            "telephone_number": "231-632-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-27",
        "last_updated": "2014-02-27",
        "status": "A",
        "authorized_official_last_name": "MONROE",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "231-632-1522",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RDN - COMMISSION DIETETIC REGISTRATION",
            "identifier": "851200",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Traverse Family Chiropractic PLLC (Grand Traverse Family Chiropractic)
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• Grand Traverse Heart Institute (Grand Traverse Heart Associates)
• Grand Traverse Industries, Inc.
• Grand Traverse Internists, PC
• Grand Traverse Ophthalmology Clinic PC
• Grand Traverse Oral Surgery, P.C.
• Grand Traverse Orthopedics PLLC
• Grand Traverse Pathology, PLLC
• Grand Traverse Pavilions

• Registered Dietitian in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2014; 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.