NPI 1104363514 · live from the CMS NPI Registry
Elise F Anderson, RD
Dietitian, Registered in Saint Michael, MN. National Provider Identifier 1104363514, active.
NPI record
| NPI | 1104363514 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 33 Main St S Ste 1, Saint Michael, MN 55376 |
| Practice phone | 763-276-1178 |
| Mailing address | 6400 Oakwood Ave Ne, Otsego, MN 55330 |
| Enumerated | January 23, 2017 |
| Last updated | November 12, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 86045878 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.