Healthcare Provider Details

I. General information

NPI: 1831815265
Provider Name (Legal Business Name): TERA-LISE M ORR MS, RD, LRD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 5TH AVE W
SABIN MN
56580-4146
US

IV. Provider business mailing address

114 5TH AVE W
SABIN MN
56580-4146
US

V. Phone/Fax

Practice location:
  • Phone: 715-781-2847
  • Fax:
Mailing address:
  • Phone: 715-781-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: