Healthcare Provider Details

I. General information

NPI: 1255587317
Provider Name (Legal Business Name): ELIZABETH JEAN STEVENS RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE HENNEPIN COUNTY MEDICAL CENTER
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVENUE SOUTH - LSB1 HENNEPIN COUNTY MEDICAL CENTER
MINNEAPOLIS MN
55415
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3623
  • Fax:
Mailing address:
  • Phone: 612-873-3044
  • Fax: 612-630-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2477
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: