Healthcare Provider Details

I. General information

NPI: 1780022202
Provider Name (Legal Business Name): TRACY KAY BJERKE R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY KAY REITH R.D., L.D.

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 AUSTIN RD STE 1
OWATONNA MN
55060-4544
US

IV. Provider business mailing address

1880 AUSTIN RD STE 1
OWATONNA MN
55060-4544
US

V. Phone/Fax

Practice location:
  • Phone: 507-774-0699
  • Fax: 888-490-2036
Mailing address:
  • Phone: 75-774-0699
  • Fax: 888-490-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3202
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: