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NPI Code Detail

MEDICARE: HOLLY WRUCK R.D., L.D.

MEDICARE: HOLLY WRUCK R.D., L.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
1133V00000XRegistered Dietitian3319MN

General Provider Information

NPI Number : 1659736445
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY WRUCK R.D., L.D.
Provider Business Mailing Address
First Line : 401 S 1ST ST UNIT 1704
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2571
Country : US
Telephone Number : 763-670-0806
Fax Number :
Provider Business Practice Location Address
First Line : 7201 METRO BLVD STE 550
Second Line :
City : EDINA
State : MN
Zip : 55439-1353
Country : US
Telephone Number : 612-234-5304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2015
Last Update Date : 01/31/2025

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Directions to “ HOLLY WRUCK R.D., L.D.” Practice Location

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