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General NPI Number Information
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NPI Number | 1558884791
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Entity Type | Organization
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Legal Business Name | MN WEIGHT CONTROL CENTERS INC.
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 3495 NORTHDALE BLVD NW STE 101
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City | COON RAPIDS
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State | MN
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Zip | 55448-6713
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Country | US
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Telephone | 763-323-4127
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Fax |
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Provider Business Mailing Address
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Address Line | 3495 NORTHDALE BLVD NW STE 101
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City | COON RAPIDS
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State | MN
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Zip | 55448-6712
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Country | US
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Telephone | 763-323-4127
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Fax |
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Authorized Official
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Title or Position | C.O.O.
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Name | ANDREA SOWERS
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Credential |
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Telephone | 763-323-4127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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