MEDICARE: SARA V BERNSTEIN RD

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	1982	MN

General Provider Information

NPI Number	:	1922034768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA V BERNSTEIN RD

Provider Business Mailing Address
First Line	:	1997 SAFARI TRL
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2610
Country	:	US
Telephone Number	:	651-702-7690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 WOODWINDS DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55125-2270
Country	:	US
Telephone Number	:	651-232-0100
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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