MEDICARE: FOOD CONNECTION 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	NV20131346778	NV

General Provider Information

NPI Number	:	1841632866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD CONNECTION LLC

Provider Business Mailing Address
First Line	:	9401 ANGELFISH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-0193
Country	:	US
Telephone Number	:	702-580-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 S GRAND CANYON DR
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7172
Country	:	US
Telephone Number	:	702-664-1204
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHELLE MAZUROWSKI
Credential	:	R.D.
Telephone Number	:	702-580-9742

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	03/22/2017

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Directions to “FOOD CONNECTION LLC ” Practice Location

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