Healthcare Provider Details

I. General information

NPI: 1760683544
Provider Name (Legal Business Name): MARY LOUISE TVEDT RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WILSON ST
MILES CITY MT
59301-5094
US

IV. Provider business mailing address

2600 WILSON ST
MILES CITY MT
59301-5094
US

V. Phone/Fax

Practice location:
  • Phone: 406-233-3074
  • Fax: 406-233-2525
Mailing address:
  • Phone: 406-233-3074
  • Fax: 406-233-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number725636
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number725636
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number103949
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: