Healthcare Provider Details

I. General information

NPI: 1912950007
Provider Name (Legal Business Name): JEAN A HARTL RDLD/CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 FRAZEE ST E
DETROIT LAKES MN
56501-3501
US

IV. Provider business mailing address

PO BOX 727
DETROIT LAKES MN
56502-0727
US

V. Phone/Fax

Practice location:
  • Phone: 218-844-2300
  • Fax: 218-844-2444
Mailing address:
  • Phone: 218-844-2300
  • Fax: 218-844-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: