MEDICARE: AMY PATEFIELD R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2319	MN

General Provider Information

NPI Number	:	1215971213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PATEFIELD R.D.

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	SUITE 314N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-645-5323
Fax Number	:	651-647-5135

Provider Business Practice Location Address
First Line	:	1660 HIGHWAY 100 S
Second Line	:	SUITE 250
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1529
Country	:	US
Telephone Number	:	651-645-5323
Fax Number	:	952-746-5962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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