Erin Jordan Pettygrove, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

86070586 Issued in CA

Practice address

1533 Lago St
San Mateo, CA 94403-2007

Phone

(434) 996-3153

NPI assigned

Jul 25, 2018

Last updated

Jul 25, 2018By the provider in NPPES

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

• Erin Nicole Jordan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1811474570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 LAGO ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032007",
            "telephone_number": "434-996-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1533 LAGO ST",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032007",
            "telephone_number": "434-996-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTYGROVE",
        "first_name": "ERIN",
        "middle_name": "JORDAN",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86070586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "JORDAN",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gretchen Kelley Petersen, R.N.
• Mackenzie Erin Peterson
• Tara Peterson, BCBA
• Frank Petropoulos
• Yashawn Pettigrew
• Melika Peyvandi
• Angel Ann Pham
• Duyen Ky Pham
• Irene Reyes Esteves Pham, RDH, MPH
• Nguyen Pham

• Registered Dietitian in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.