MEDICARE: IVONE ALEJANDRA LURSSEN

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	:	1417807348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVONE ALEJANDRA LURSSEN

Provider Business Mailing Address
First Line	:	26 PIERCE ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-1130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 PIERCE ST
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-1130
Country	:	US
Telephone Number	:	401-500-9449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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