MEDICARE: NOURISHING WAVES NUTRITION PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1528822624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHING WAVES NUTRITION PLLC

Provider Business Mailing Address
First Line	:	4145 42ND AVE S UNIT 2
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 DUPONT AVE S STE 202
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2719
Country	:	US
Telephone Number	:	952-358-1414
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNIE CLARKIN
Credential	:	RDN, LD
Telephone Number	:	952-358-1414

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/18/2024

Similar Medicare Providers

1841796414 — LARRY ANDERSON PSYD LLC
Practice Location Address:

2124 DUPONT AVE S STE 202
MINNEAPOLIS, MN
55405-2719

Practice Phone: 612-718-0894
Practice Fax: 612-879-0059

1497354344 — KAYCIE DALE
Practice Location Address:

2124 DUPONT AVE S STE 201
MINNEAPOLIS, MN
55405-2719

Practice Phone: 651-300-3688
Practice Fax:

1083386197 — ANNIE LYNN CLARKIN RDN, LD
Practice Location Address:

2124 DUPONT AVE S STE 202
MINNEAPOLIS, MN
55405-2719

Practice Phone: 952-358-1414
Practice Fax:

1659986958 — JAYNE GARTHUS
Practice Location Address:

6900 78TH AVE N
MINNEAPOLIS, MN
55445-2719

Practice Phone: 218-391-3215
Practice Fax:

1548893381 — AE VANG-XIONG LICSW
Practice Location Address:

1100 GLENWOOD AVE
MINNEAPOLIS, MN
55405-1430

Practice Phone: 612-781-1454
Practice Fax:

1528910072 — NOWMED PLLC
Practice Location Address:

2909 WAYZATA BLVD STE 31328
MINNEAPOLIS, MN
55405-2126

Practice Phone: 651-300-3077
Practice Fax:

Directions to “NOURISHING WAVES NUTRITION PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.