Healthcare Provider Details

I. General information

NPI: 1710446695
Provider Name (Legal Business Name): MEGAN HYDUKOVICH RDN, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14688 EVERTON AVE N
HUGO MN
55038-6071
US

IV. Provider business mailing address

1690 UNIVERSITY AVE W STE 400
SAINT PAUL MN
55104-3729
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1009655
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: