Provider Demographics
NPI:1093984882
Name:BISEK, LAURA (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BISEK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 WILLARD ST W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5657
Mailing Address - Country:US
Mailing Address - Phone:612-270-7349
Mailing Address - Fax:
Practice Address - Street 1:621 WILLARD ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5657
Practice Address - Country:US
Practice Address - Phone:612-270-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered