Healthcare Provider Details

I. General information

NPI: 1982787339
Provider Name (Legal Business Name): BARBARA ANN OEMCKE RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

31807 MARIGOLD LN
AVON MN
56310-8638
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 701-239-3729
Mailing address:
  • Phone: 320-845-2709
  • Fax: 701-239-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR639606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: