New Leaf Nutrition LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LDD10150450 Issued in OR

Legal business name

NEW LEAF NUTRITION LLC

Practice address

5261 N Port Washington Rd
Glendale, WI 53217-4903

Phone

(206) 948-8810

NPI assigned

Apr 13, 2017

Organization subpart

No

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

Authorized official

Name

Lindsay Keeney

Title

Rd

Phone

(206) 948-8810

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1780118992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5261 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174903",
            "telephone_number": "206-948-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5261 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174903",
            "telephone_number": "206-948-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LEAF NUTRITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-13",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "KEENEY",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_title_or_position": "RD",
        "authorized_official_telephone_number": "206-948-8810"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LDD10150450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500703686",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Glendale, WI
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• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; 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.