Healthcare Provider Details

I. General information

NPI: 1457886400
Provider Name (Legal Business Name): CHEFRDN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EAST 4TH STREET
DULUTH MN
55805
US

IV. Provider business mailing address

1101 EAST 4TH STREET
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 320-250-5314
  • Fax:
Mailing address:
  • Phone: 320-250-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3819
License Number StateMN

VIII. Authorized Official

Name: RANELLE KIRCHNER
Title or Position: OWNER/OPERATOR/DIETITIAN
Credential: MS, RD, LDN
Phone: 320-250-5314