MP Nutrition Therapy LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

MP NUTRITION THERAPY LLC

Practice address

189 Liberty St NE Ste 210C
Salem, OR 97301-3682

Phone

(503) 983-7446

Fax

(503) 483-2546

NPI assigned

Aug 20, 2020

Last updated

Apr 6, 2022By 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

Maia Penchansky, RDN LDNNPI 1548743354

Title

Owner, Registered Dietitian

Phone

(503) 983-7446

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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.

• Maia Lucy Penchansky, PCA, RD, LD

  • Mental Health Counselor
  • Portland, OR
  • NPI 1548743354

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1396357265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 LIBERTY ST NE STE 210C",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013682",
            "telephone_number": "503-983-7446",
            "fax_number": "503-483-2546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 LIBERTY ST NE STE 210C",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013682",
            "telephone_number": "503-983-7446",
            "fax_number": "503-483-2546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "189 Liberty St NE Ste 204B",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013682",
            "country_code": "US",
            "telephone_number": "503-983-7446",
            "fax_number": "503-683-8621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MP NUTRITION THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-20",
        "last_updated": "2022-04-06",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "PENCHANSKY",
        "authorized_official_first_name": "MAIA",
        "authorized_official_title_or_position": "OWNER, REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "503-983-7446",
        "authorized_official_credential": "RDN LDN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500754422",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maia@maiaprd.com",
            "affiliation": "N",
            "endpointDescription": "Confidential email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "189 Liberty St NE Ste 210C",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973013682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jolene Mouritsen, EFDA
• Sam Sarkis Moursalian, D.C.
• Kerry I Moyer, LPC
• Christine Moylan, RN
• Everett J Mozell, M.D.
• Erin Nicole Muchmore, RDH
• Heather Muchmore, LMT
• Enoch K Mudd
• Joanne Mueller
• Scott V Mueller, DPT

• Registered Dietitian in Salem, OR
• Providers in Salem, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.