MEDICARE: MS. KATHERINE THISTLE RIVARD RD,LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1916	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	816463	OTHER	MN	AMERICAN DIETETIC ASSOCIATION

General Provider Information

NPI Number	:	1235472275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE THISTLE RIVARD RD,LD

Provider Business Mailing Address
First Line	:	11240 CEDAR POINTE
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305
Country	:	US
Telephone Number	:	763-370-9569
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 GLENBROOK AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55128-6508
Country	:	US
Telephone Number	:	651-387-9902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	01/23/2026

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