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NPI Code Detail

MEDICARE: YOUTH DETERMINED TO SUCCEED

MEDICARE: YOUTH DETERMINED TO SUCCEED
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
1133NN1002XNutrition Education Nutritionist

General Provider Information

NPI Number : 1538403365
Entity Type Code : Organization
Provider Name (Legal Business Name) : YOUTH DETERMINED TO SUCCEED
Provider Business Mailing Address
First Line : 3333 N 4TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3333 N 4TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-2615
Country : US
Telephone Number : 612-486-6720
Fax Number :
Authorized Official
Title or Position : EXECUTIVE OFFICER
Name : MELVIN ANDERSON
Credential :
Telephone Number : 612-486-6730
Provider Enumeration Date : 11/16/2012
Last Update Date : 03/04/2013

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Directions to “YOUTH DETERMINED TO SUCCEED ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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