Danielle Marianna Larson, RDN, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164.006671 Issued in IL

Practice address

1017 Jefferson St
Pekin, IL 61554-1640

Phone

(217) 416-3101

NPI assigned

Dec 21, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Danielle Marianna Sausaman Former name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nourish, Inc.

  • Registered Dietitian
  • Austin, TX
  • NPI 1558097824

  Dietitian, Registered

  Medicare reassignment NPD

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1417312232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 JEFFERSON ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615541640",
            "telephone_number": "217-416-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 JEFFERSON ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615541640",
            "telephone_number": "217-416-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "DANIELLE",
        "middle_name": "MARIANNA",
        "credential": "RDN, LD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-21",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.006671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "SAUSAMAN",
            "middle_name": "MARIANNA",
            "credential": "RDN, LD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Zackary Steven Lloyd Ladson, PA
• Austin Lair
• Timothy Michael Lamb, MA LCPC
• Jaclyn Rene Lamer, CPNP-AC, PMHNP-BC
• Alicia J Langley, LSW, CADC
• Renee R Lawson, RSA DSP CNA
• Gina Leach
• Nicole Leavitt, PTA
• Jeffrey B Lee Ho, MD
• Cheryl A Leneve, PA-C

• Registered Dietitian in Pekin, IL
• Providers in Pekin, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.