Healthcare Provider Details

I. General information

NPI: 1659033272
Provider Name (Legal Business Name): DEANNA ANN ZOOK RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 BLACKFOOT ST NW STE 300
COON RAPIDS MN
55433-2772
US

IV. Provider business mailing address

3007 WINNIPEG DR
BISMARCK ND
58503-0450
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-0808
  • Fax: 763-236-6065
Mailing address:
  • Phone: 701-426-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4540
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: