MEDICARE: MICHELLE MAZUROWSKI MS,RDN,LD,LPTA

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	929429	NV

General Provider Information

NPI Number	:	1639511652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MAZUROWSKI MS,RDN,LD,LPTA

Provider Business Mailing Address
First Line	:	11829 LUNA DEL MAR LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-4529
Country	:	US
Telephone Number	:	702-580-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 S GRAND CANYON DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7173
Country	:	US
Telephone Number	:	702-580-9742
Fax Number	:

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

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	05/17/2026

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