Organization
MK-RDNUTRITION
Active
Other names
CREATING A NEW NORM
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE KONSTANTARAKIS R.D. (PRESIDENT)
(702) 589-1414
Entity
Organization
Contact information
Practice address
6040 S FORT APACHE RD, SUITE #100, LAS VEGAS, NV 89148-5655
(702) 781-2577
Mailing address
6040 S FORT APACHE RD STE 100, LAS VEGAS, NV 89148-5613
(702) 475-4007
(702) 475-4060
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
32302D1-0
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32302D1-0
NV DIETITIAN LICENSE
NV
Enumeration date
04/25/2017
Last updated
09/02/2024
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