Healthcare Provider Details

I. General information

NPI: 1376681312
Provider Name (Legal Business Name): TARA L PASCHKA RDLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 30TH AVENUE WEST ALEXANDRIA CLINIC PA
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

610 30TH AVENUE WEST ALEXANDRIA CLINIC PA
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5123
  • Fax: 320-763-7883
Mailing address:
  • Phone: 320-763-5123
  • Fax: 320-763-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1263
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: