Healthcare Provider Details

I. General information

NPI: 1952572703
Provider Name (Legal Business Name): MORGAN KRISTINE MEINECKE R.D. , L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN KRISTINE KURTZ R.D. , L.D.

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PARK NICOLLET BLVD PARK NICOLLET-FAMILY PRACTICE NUTRITION
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

3850 PARK NICOLLET BLVD PARK NICOLLET-FAMILY PRACTICE NUTRITION
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-0248
  • Fax:
Mailing address:
  • Phone: 952-993-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2708
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01725
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: