Healthcare Provider Details

I. General information

NPI: 1255708368
Provider Name (Legal Business Name): ALLISON TRACY TURNQUIST DOERFLER RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE #1300 CENTRACARE CLINIC WOMEN AND CHILDREN ALLERGY/IMMUNOLOGY
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE #1300 CENTRACARE CLINIC WOMEN AND CHILDREN ALLERGY/IMMUNOLOGY
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3650
  • Fax: 320-654-3647
Mailing address:
  • Phone: 320-654-3650
  • Fax: 320-654-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3540
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: