Nourished Living LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

NOURISHED LIVING LLC

Practice address

22811 Greater Mack Ave Ste 210
Saint Clair Shores, MI 48080-2054

Phone

(248) 288-2680

NPI assigned

Sep 28, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Bethany A Matus, RD

Title

Authorized Official/Owner

Phone

(313) 288-2680

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1942817580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 CANTERBURY RD",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361278",
            "telephone_number": "313-288-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE STE 210",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802054",
            "telephone_number": "248-288-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOURISHED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "MATUS",
        "authorized_official_first_name": "BETHANY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/OWNER",
        "authorized_official_telephone_number": "313-288-2680",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.