Provider Demographics
NPI:1225304389
Name:TWIN CITIES NUTRITION CONSULTANTS, LLC
Entity Type:Organization
Organization Name:TWIN CITIES NUTRITION CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:612-419-8955
Mailing Address - Street 1:1250 YANKEE DOODLE RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2231
Mailing Address - Country:US
Mailing Address - Phone:612-419-8955
Mailing Address - Fax:
Practice Address - Street 1:1250 YANKEE DOODLE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2231
Practice Address - Country:US
Practice Address - Phone:612-419-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2880261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center