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General NPI Number Information
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NPI Number | 1598640930
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Entity Type | Individual
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Provider Name | ALICIA REARDON NDTR
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 600 PLEASANT AVE S
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City | PARK RAPIDS
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State | MN
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Zip | 56470-1431
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Country | US
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Telephone | 218-616-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 17664 SUNNY HILL DR
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City | LAPORTE
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State | MN
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Zip | 56461-5084
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Country | US
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Telephone | 952-486-2231
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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 | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number | 86170823
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License Number State | MN
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