Healthcare Provider Details

I. General information

NPI: 1750999488
Provider Name (Legal Business Name): KATIE LYNN HOBAN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26246 CRANE RD
WHITE EARTH MN
56591-9998
US

IV. Provider business mailing address

PO BOX 496
WHITE EARTH MN
56591-0496
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-3286
  • Fax: 218-983-3724
Mailing address:
  • Phone: 218-983-3286
  • Fax: 218-983-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2709
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: