Healthcare Provider Details

I. General information

NPI: 1548775067
Provider Name (Legal Business Name): LAURA FISCHER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 26TH AVE S
MINNEAPOLIS MN
55406-3040
US

IV. Provider business mailing address

4104 26TH AVE S
MINNEAPOLIS MN
55406-3040
US

V. Phone/Fax

Practice location:
  • Phone: 530-574-6721
  • Fax:
Mailing address:
  • Phone: 530-574-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: