Provider Demographics
NPI:1194212365
Name:BUTTERBRODT, ALEXANDRA KAY (RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:KAY
Last Name:BUTTERBRODT
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2158
Mailing Address - Country:US
Mailing Address - Phone:507-526-7388
Mailing Address - Fax:
Practice Address - Street 1:515 S MOORE ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-2158
Practice Address - Country:US
Practice Address - Phone:507-526-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered