Healthcare Provider Details

I. General information

NPI: 1346038718
Provider Name (Legal Business Name): ALEXANDRA EVANSON MS, RD, LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WESTVIEW LN
OXBOW ND
58047-7200
US

IV. Provider business mailing address

114 WESTVIEW LN
OXBOW ND
58047-7200
US

V. Phone/Fax

Practice location:
  • Phone: 651-269-2844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1326
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: