Healthcare Provider Details

I. General information

NPI: 1831782242
Provider Name (Legal Business Name): KATIE SKARDA RDN, LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 2
MINOT ND
58701-4667
US

IV. Provider business mailing address

1 BURDICK EXPY W STE 202
MINOT ND
58701-4406
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5268
  • Fax: 701-857-5593
Mailing address:
  • Phone: 701-857-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1202
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: