Provider Demographics
NPI:1174285803
Name:BREKKEN, ANGELA K (EDD MS RD LD FAND)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:BREKKEN
Suffix:
Gender:F
Credentials:EDD MS RD LD FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8701
Mailing Address - Country:US
Mailing Address - Phone:218-209-8723
Mailing Address - Fax:
Practice Address - Street 1:1840 15TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8701
Practice Address - Country:US
Practice Address - Phone:218-209-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered