MEDICARE: NEPHROLOGY NUTRITION SERVICES

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	133VN1005X	Renal Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1518396001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEPHROLOGY NUTRITION SERVICES

Provider Business Mailing Address
First Line	:	450 THIS WAY ST STE B
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5152
Country	:	US
Telephone Number	:	979-299-0091
Fax Number	:	979-297-3330

Provider Business Practice Location Address
First Line	:	450 THIS WAY ST STE B
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5152
Country	:	US
Telephone Number	:	979-299-0091
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MARGARITA FELAN
Credential	:
Telephone Number	:	979-299-0091

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	07/21/2021

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