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General NPI Number Information
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NPI Number | 1164844304
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Entity Type | Individual
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Provider Name | MICHELLE MEZERA RD, LD
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Gender | Female
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 7373 FRANCE AVE S STE 202
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City | EDINA
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State | MN
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Zip | 55435-4551
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Country | US
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Telephone | 952-835-1311
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Fax | 952-428-0099
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Provider Business Mailing Address
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Address Line | PO BOX 206
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City | MINNEAPOLIS
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State | MN
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Zip | 55480-0206
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Country | US
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Telephone | 612-262-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2940
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License Number State | MN
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