Healthcare Provider Details

I. General information

NPI: 1164577110
Provider Name (Legal Business Name): CAROL DIANE SCHNEIDER MS,RD,LD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 98TH ST
BLOOMINGTON MN
55420-4773
US

IV. Provider business mailing address

614 PLEASANT ST
EXCELSIOR MN
55331-3036
US

V. Phone/Fax

Practice location:
  • Phone: 952-885-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number702975
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: