Active NPI
Jessica Pauline Lundberg
- Registered Dietitian
- West Des Moines, IA
National Provider Identifier
1790409241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86116754
- Practice address
- 6000 University Ave
West Des Moines, IA 50266-8203 - Phone
- (515) 241-8686
- NPI assigned
- Sep 28, 2022
- 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 | 86116754 | IA | Primary |
Addresses
Primary practice location
6000 University Ave
West Des Moines, IA 50266-8203
Mailing address
6500 Ep True Pkwy Apt 3205
West Des Moines, IA 50266-5263
Phone (515) 210-4297
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 |
|---|---|---|---|
| 86116754 | IA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1790409241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 EP TRUE PKWY APT 3205",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502665263",
"telephone_number": "515-210-4297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6000 UNIVERSITY AVE",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502668203",
"telephone_number": "515-241-8686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDBERG",
"first_name": "JESSICA",
"middle_name": "PAULINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-28",
"last_updated": "2022-09-28",
"certification_date": "2022-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "86116754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.