MEDICARE: CRUA NUTRITION LLC

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	:	1497592968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRUA NUTRITION LLC

Provider Business Mailing Address
First Line	:	14 BENNETT RD
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-1832
Country	:	US
Telephone Number	:	508-254-5639
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 FAUNCE CORNER RD STE 630
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-1209
Country	:	US
Telephone Number	:	774-377-9229
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/OWNER
Name	:	KATLYNN KISLA
Credential	:	MS, RDN, LDN
Telephone Number	:	508-254-5639

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	04/02/2026

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