Provider Demographics
NPI:1992429708
Name:LUHAN-NORDBERG, MICHELLE (MS,RD,CDN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:LUHAN-NORDBERG
Suffix:
Gender:F
Credentials:MS,RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MANCHESTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3219
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:
Practice Address - Street 1:856 HEALTH SCIENCES ROAD
Practice Address - Street 2:SUITE 2600
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617
Practice Address - Country:US
Practice Address - Phone:949-824-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY867430133V00000X
CARD867430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered