Provider Demographics
NPI:1992250302
Name:GRGURICH, TAYLOR NICOLE (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:GRGURICH
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S D ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-3202
Mailing Address - Country:US
Mailing Address - Phone:641-673-8663
Mailing Address - Fax:
Practice Address - Street 1:3210 SE CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-7405
Practice Address - Country:US
Practice Address - Phone:866-716-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083778133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered