Vanessa Mack, RD
Individual provider Active NPI Registered Dietitian · Nicollet, MN
NPI 1740977362 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1740977362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- 1040868 (MN)
- Practice address
- 46114 506TH St
Nicollet, MN 56074-4003 - Phone
- (507) 276-1463
- NPI assigned
- Apr 24, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mankato Clinic LTD
Practice addresses (Care Compare)
1230 E Main St
Mankato, MN 56001-5066
Phone (507) 389-8509
1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240402002602 | MN | Practitioner - Registered Dietitian Or Nutrition Professional | 3072951607 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1040868 | MN | MD | Registered Dietitian |
| 5209 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mankato Clinic LTD | Current |
Accepting new patients |
Locations
1230 E Main St
Mankato, MN 56001
Phone (507) 389-8502
Interoperability endpoints
- vanessamack@mklt.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1040868 | MN | Yes |
Addresses
Primary practice location
46114 506TH St
Nicollet, MN 56074-4003
Mailing address
46114 506TH St
Nicollet, MN 56074-4003
Phone (507) 276-1463
Other providers in Nicollet, MN
- Kathryn Jane Billings
- Discover Chiropractic
- Patrick Steven Kunerth
- Andrea Jane Mettler
- Nicollet Public School District 507
- Frederick Monroe Severson
All providers in Nicollet, MN · Registered Dietitian in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.