Healthcare Provider Details

I. General information

NPI: 1720707888
Provider Name (Legal Business Name): JAMI SUE ROKALA RDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PAUL BUNYAN DR S
BEMIDJI MN
56601-3236
US

IV. Provider business mailing address

43000 COUNTY 3
LAPORTE MN
56461-4139
US

V. Phone/Fax

Practice location:
  • Phone: 218-689-1907
  • Fax: 218-229-6054
Mailing address:
  • Phone: 218-689-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: