Healthcare Provider Details

I. General information

NPI: 1740541218
Provider Name (Legal Business Name): KATIE FRUSHOUR R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

449 TUSKEGEE AIRMAN BOULEVARD BUILDING 308
GRAND FORKS ND
58205
US

V. Phone/Fax

Practice location:
  • Phone: 505-853-4884
  • Fax:
Mailing address:
  • Phone: 701-747-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1033610
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: