Healthcare Provider Details

I. General information

NPI: 1346122256
Provider Name (Legal Business Name): BREANNA BJERKE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S # 1706
FARGO ND
58103-4940
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-417-4174
  • Fax:
Mailing address:
  • Phone: 701-417-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1288
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: