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Individual
ELLISA NYBERG
Active
Individual
ELLISA NYBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, LN, LD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0219
SD
133V00000X
Registered Dietitian
2298
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11282001
UMR
SD
05
—
11282001
—
SD
Enumeration date
07/12/2019
Last updated
07/12/2019
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