| Simplistic Nutrition Llc | |
|
116 W Grand Ave Ste 210 Port Washington WI 53074-2242 | |
| (224) 221-1339 | |
| Not Available |
| Full Name | Simplistic Nutrition Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 116 W Grand Ave Ste 210, Port Washington, Wisconsin |
| Authorized Official Name and Position | Brianna Jurss (OWNER) |
| Authorized Official Contact | 2242211339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simplistic Nutrition Llc 817 Glenlyon Ln Port Washington WI 53074-9691 Ph: (224) 221-1339 | Simplistic Nutrition Llc 116 W Grand Ave Ste 210 Port Washington WI 53074-2242 Ph: (224) 221-1339 |
| NPI Number | 1063258275 |
|---|---|
| Provider Enumeration Date | 07/08/2024 |
| Last Update Date | 07/08/2024 |
| Certification Date | 07/07/2024 |
| Medicare PECOS PAC ID | 9335670249 |
|---|---|
| Medicare Enrollment ID | O20241002003956 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063258275 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Brianna Leslie Jurss |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1376389585 PECOS PAC ID: 0244761153 Enrollment ID: I20241002003993 |
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