MEDICARE: NUTRIFYI, 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	987208	AZ

General Provider Information

NPI Number	:	1932530771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRIFYI, LLC

Provider Business Mailing Address
First Line	:	544 N ALMA SCHOOL RD
Second Line	:	#5
City	:	MESA
State	:	AZ
Zip	:	85201-5473
Country	:	US
Telephone Number	:	602-803-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 N ALMA SCHOOL RD
Second Line	:	#5
City	:	MESA
State	:	AZ
Zip	:	85201-5473
Country	:	US
Telephone Number	:	602-803-4522
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/OWNER
Name	:	ANTOINETTA V ANSELMO
Credential	:	R.D.
Telephone Number	:	602-803-4522

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	12/04/2013

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Directions to “NUTRIFYI, LLC ” Practice Location

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