MEDICARE: NATURE & NURTURE NUTRITION THERAPY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346623634	OTHER	NV	NPPES

General Provider Information

NPI Number	:	1447072186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURE & NURTURE NUTRITION THERAPY

Provider Business Mailing Address
First Line	:	2109 LONE DESERT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1117
Country	:	US
Telephone Number	:	877-811-1178
Fax Number	:	877-811-1178

Provider Business Practice Location Address
First Line	:	2109 LONE DESERT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1117
Country	:	US
Telephone Number	:	877-811-1178
Fax Number	:	877-811-1178

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANGELA CHRISTINE STORCK-PETERSEN
Credential	:	MPH, MS, RD/LD, CEDS
Telephone Number	:	877-811-1178

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	10/24/2024

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