MEDICARE: NOURISHED WITH RACHAEL 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	:	1508547449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOURISHED WITH RACHAEL LLC

Provider Business Mailing Address
First Line	:	12 ROTHERWOOD RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 ROTHERWOOD RD
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-2438
Country	:	US
Telephone Number	:	617-935-3314
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	RACHAEL UTSTEIN
Credential	:
Telephone Number	:	617-935-3314

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	08/15/2023

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