Healthcare Provider Details

I. General information

NPI: 1508254442
Provider Name (Legal Business Name): BETSY PLOTZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W MAIN ST STE 200
MARSHALL MN
56258-3171
US

IV. Provider business mailing address

607 W MAIN ST STE 200
MARSHALL MN
56258-3171
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-6713
  • Fax: 507-537-6719
Mailing address:
  • Phone: 507-537-6713
  • Fax: 507-537-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: