MLC Nutrition, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

MLC NUTRITION, LLC

Practice address

219 N Main Ave # 152
Scranton, PA 18504-3307

Phone

(570) 731-3200

Fax

(570) 343-2401

NPI assigned

Aug 27, 2021

Organization subpart

No

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

Authorized official

Name

Marissa Campanella, RDN, LDN, CEDRDNPI 1164838694

Title

Registered Dietitian

Phone

(570) 731-3200

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marissa Campanella, RD, LDN, CEDRD

  • Registered Dietitian
  • Scranton, PA
  • NPI 1164838694

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1851068746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 N MAIN AVE # 152",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185043307",
            "telephone_number": "570-731-3200",
            "fax_number": "570-343-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 N MAIN AVE # 152",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185043307",
            "telephone_number": "570-731-3200",
            "fax_number": "570-343-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLC NUTRITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "CAMPANELLA",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "570-731-3200",
        "authorized_official_credential": "RDN, LDN, CEDRD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Jane Miskovsky, CRNP
• Carla Marie Mitchell
• Jennifer Mitchell, MS, OTR/L, CBIS
• Kelly Mitchell
• Linda Mitchell, CRNA
• Mobility Express of Scranton, Inc
• Mobility Express of Scranton, Inc.
• Stephen E Mock, PH.D.
• Naman Modi, M.D.
• Keisha Moeller, BCBA

• Registered Dietitian in Scranton, PA
• Providers in Scranton, PA by specialty
• Registered Dietitian in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.