Healthcare Provider Details

I. General information

NPI: 1841268109
Provider Name (Legal Business Name): LINDA SUE CARRUTHERS REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S COUNTY ROAD 5
SPRINGFIELD MN
56087-2102
US

IV. Provider business mailing address

410 E COTTONWOOD ST
SPRINGFIELD MN
56087-2602
US

V. Phone/Fax

Practice location:
  • Phone: 507-723-3200
  • Fax: 507-723-6489
Mailing address:
  • Phone: 507-723-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1047
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: