Healthcare Provider Details

I. General information

NPI: 1154558757
Provider Name (Legal Business Name): GEORGIANNA WALKER MS, LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 2ND ST SE
NEW ROCKFORD ND
58356-1951
US

IV. Provider business mailing address

319 2ND ST SE
NEW ROCKFORD ND
58356-1951
US

V. Phone/Fax

Practice location:
  • Phone: 701-947-5950
  • Fax: 701-947-5950
Mailing address:
  • Phone: 701-947-5950
  • Fax: 701-947-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number89
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: