Active NPI
Monica Lursen, REGISTERED DIETICIAN
- Registered Dietitian
- Waverly, IA
National Provider Identifier
1417176785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 00410
- Practice address
- 312 9TH St SW
Waverly, IA 50677-2929 - Phone
- (319) 352-4902
- NPI assigned
- Apr 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 00410 | IA | Primary |
Addresses
Primary practice location
312 9TH St SW
Waverly, IA 50677-2929
Mailing address
27924 Butler Center Rd
Clarksville, IA 50619-9180
Phone (319) 352-4902
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00410 | Other | IA | IA LICENSE |
| 368373 | Other | IA | CDR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00410 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417176785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27924 BUTLER CENTER RD",
"city": "CLARKSVILLE",
"state": "IA",
"postal_code": "506199180",
"telephone_number": "319-352-4902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 9TH ST SW",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506772929",
"telephone_number": "319-352-4902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LURSEN",
"first_name": "MONICA",
"credential": "REGISTERED DIETICIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "00410",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA LICENSE",
"identifier": "00410",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDR",
"identifier": "368373",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waverly, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.