Healthcare Provider Details

I. General information

NPI: 1831919455
Provider Name (Legal Business Name): NOURISHED RD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S WAYFARER
MESA AZ
85204-6239
US

IV. Provider business mailing address

1310 S WAYFARER
MESA AZ
85204-6239
US

V. Phone/Fax

Practice location:
  • Phone: 480-464-1959
  • Fax:
Mailing address:
  • Phone: 480-464-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA CURTIS
Title or Position: LEAD DIETITIAN
Credential: RD
Phone: 480-532-5980