Healthcare Provider Details

I. General information

NPI: 1770829970
Provider Name (Legal Business Name): CASEY M BJORALT LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 3RD ST SE
HILLSBORO ND
58045-4840
US

IV. Provider business mailing address

1720 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-636-3239
  • Fax:
Mailing address:
  • Phone: 701-461-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number915
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: