NPI 1154894434 · live from the CMS NPI Registry
Michael Blake, MS, RD, LRD
Dietitian, Registered in Fargo, ND. National Provider Identifier 1154894434, active.
NPI record
| NPI | 1154894434 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 2400 32nd Ave S, Fargo, ND 58103 |
| Practice phone | 701-234-2245 |
| Mailing address | Po Box 5074, Sioux Falls, SD 57117 |
| Enumerated | January 9, 2019 |
| Last updated | May 12, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 1187 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.